Healthcare Provider Details

I. General information

NPI: 1225072770
Provider Name (Legal Business Name): WALDEMAR ALBERTO CARLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WALLY A CARLO

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVE S STE 9380
BIRMINGHAM AL
35233-1802
US

IV. Provider business mailing address

1700 6TH AVE S STE 9380
BIRMINGHAM AL
35233-1802
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4680
  • Fax:
Mailing address:
  • Phone: 205-934-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number15593
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: