Provider Demographics
NPI:1194879080
Name:MICHAEL E CARLOS MD LLC
Entity type:Organization
Organization Name:MICHAEL E CARLOS MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-604-0110
Mailing Address - Street 1:14201 LAUREL PARK DR
Mailing Address - Street 2:SUITE 223
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5203
Mailing Address - Country:US
Mailing Address - Phone:301-604-0110
Mailing Address - Fax:301-604-0096
Practice Address - Street 1:14201 LAUREL PARK DR
Practice Address - Street 2:SUITE 223
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:301-604-0110
Practice Address - Fax:301-604-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty