Healthcare Provider Details

I. General information

NPI: 1649134677
Provider Name (Legal Business Name): CAROLINA DARCY ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 FREDERICK RD
CATONSVILLE MD
21228-4625
US

IV. Provider business mailing address

1105 PLEASANT VALLEY DR
CATONSVILLE MD
21228-2644
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-1115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number9004
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: