Provider Demographics
NPI:1285779645
Name:RECALDE, CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:RECALDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 4TH ST
Mailing Address - Street 2:PLEASANT ACRES
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1316
Mailing Address - Country:US
Mailing Address - Phone:717-248-9694
Mailing Address - Fax:
Practice Address - Street 1:307 4TH ST
Practice Address - Street 2:PLEASANT ACRES
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1316
Practice Address - Country:US
Practice Address - Phone:717-248-9694
Practice Address - Fax:717-248-5806
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034182E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41242Medicare UPIN