Provider Demographics
NPI:1851319321
Name:CARRASQUILLO, INES M (MD)
Entity type:Individual
Prefix:DR
First Name:INES
Middle Name:M
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:809 82ND PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:809 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4607
Practice Address - Country:US
Practice Address - Phone:843-692-4759
Practice Address - Fax:956-682-4689
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY163791207QH0002X, 2082S0099X, 2082S0105X
IL122279207QH0002X
SC83637207QH0002X
WI525092082S0099X, 2082S0105X
TXQ80312086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3654790-01Medicaid
TX3654790-01Medicaid
TX542926YKSJMedicare PIN