Provider Demographics
NPI:1306887500
Name:PINTO, CARMEN (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:PINTO
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 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-766-1222
Practice Address - Street 1:1311 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2621
Practice Address - Country:US
Practice Address - Phone:270-769-1304
Practice Address - Fax:270-234-8028
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY296182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY235783OtherTRICARE
KY000000044419OtherANTHEM
KY30605018Medicaid
KY235783OtherTRICARE
KY0762211Medicare ID - Type UnspecifiedMEDICARE
KY0358817Medicare UPIN
KY0359006Medicare ID - Type UnspecifiedMEDICARE
0026644Medicare ID - Type Unspecified
KY0358619Medicare ID - Type UnspecifiedMEDICARE
KY30605018Medicaid
KY0358706Medicare ID - Type UnspecifiedMEDICARE
KY0358916Medicare ID - Type UnspecifiedMEDICARE