Provider Demographics
NPI:1699787689
Name:SOTO, CARLOS A (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:325 BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4167
Mailing Address - Country:US
Mailing Address - Phone:803-773-5227
Mailing Address - Fax:803-774-5400
Practice Address - Street 1:4700 FOREST DR STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-3119
Practice Address - Country:US
Practice Address - Phone:803-773-5227
Practice Address - Fax:803-774-5400
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC25518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC255182Medicaid
SC255182Medicaid
SCI06198Medicare UPIN