Provider Demographics
NPI:1699774497
Name:MACLEOD, CARLA BELTRAN (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:BELTRAN
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1738
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-1738
Mailing Address - Country:US
Mailing Address - Phone:301-926-4707
Mailing Address - Fax:201-926-4708
Practice Address - Street 1:18207A FLOWER HILL WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5331
Practice Address - Country:US
Practice Address - Phone:301-926-4707
Practice Address - Fax:301-926-4708
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042212207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010071976Medicaid
E93921Medicare UPIN