Provider Demographics
NPI:1356417166
Name:MARRERO, CARLOS JOSE (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:JOSE
Last Name:MARRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 UNITY PLAZA
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650
Mailing Address - Country:US
Mailing Address - Phone:324-532-1511
Mailing Address - Fax:724-532-0941
Practice Address - Street 1:324 UNITY PLAZA
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650
Practice Address - Country:US
Practice Address - Phone:324-532-1511
Practice Address - Fax:724-532-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA041463L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012270550003Medicaid
PA612626Medicare ID - Type Unspecified
A61279Medicare UPIN