Healthcare Provider Details

I. General information

NPI: 1659365559
Provider Name (Legal Business Name): CARMEN L TALARICO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAROLINAS MEDICAL CENTER 1000 BLYTHE BLVD
CHARLOTTE NC
28232
US

IV. Provider business mailing address

CHARLOTTE RADIOLOGY, P.A. 3030 LATROBE DRIVE
CHARLOTTE NC
28211
US

V. Phone/Fax

Practice location:
  • Phone: 704-362-1945
  • Fax: 704-362-7058
Mailing address:
  • Phone: 704-362-1945
  • Fax: 704-362-7058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number38857
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38857
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: