Provider Demographics
NPI:1548011406
Name:PATINO, CARLOS ANDRES (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANDRES
Last Name:PATINO
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 1:37 FARRAGUT RD APT 7
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1714
Mailing Address - Country:US
Mailing Address - Phone:407-494-9484
Mailing Address - Fax:
Practice Address - Street 1:330 MOUNT AUBURN
Practice Address - Street 2:SOUTH 2 330 MOUNT AUBURN STREET C
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-499-5571
Practice Address - Fax:617-499-5593
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program