Healthcare Provider Details

I. General information

NPI: 1508032244
Provider Name (Legal Business Name): HEATHER NOELLE DI CARLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST STE 7304 JOHNS HOPKINS MEDICINE
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

777 SOUTH EDEN ST APT 924
BALTIMORE MD
21231
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5358
  • Fax:
Mailing address:
  • Phone: 631-379-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberD0078254
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: