MEDICARE: CARLOS N PATALINGHUG SR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D18426	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4379833	OTHER		AETNA
2	6681CN	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1235136813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS N PATALINGHUG SR. M.D.

Provider Business Mailing Address
First Line	:	5410 RITCHIE HWY
Second Line	:	STE B
City	:	BROOKLYN PARK
State	:	MD
Zip	:	21225-3069
Country	:	US
Telephone Number	:	410-354-4100
Fax Number	:	410-354-4350

Provider Business Practice Location Address
First Line	:	5410 RITCHIE HWY
Second Line	:	STE B
City	:	BROOKLYN PARK
State	:	MD
Zip	:	21225-3069
Country	:	US
Telephone Number	:	410-354-4100
Fax Number	:	410-354-4350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	03/03/2017

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