Basic Information
| Provider Information | |||||||||
| NPI: | 1235257668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GADEA | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | ACEVEDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 922 LUCERNE TERRACE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074268660 | ||||||||
| FaxNumber: | 4078391426 | ||||||||
| Practice Location | |||||||||
| Address1: | 922 LUCERNE TER | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074268660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 231968 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RH0003X | ME120736 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | P00435673 | 01 | AR | RR MEDICARE | OTHER |