Basic Information
| Provider Information | |||||||||
| NPI: | 1952362899 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARMONA AND DENNSTEDT MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2555 PONCE DELEON BLVD | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057025135 | ||||||||
| FaxNumber: | 3054412144 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 N WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | TITUTSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212686111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | CARMONA | ||||||||
| AuthorizedOfficialFirstName: | PEDRO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3212686111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 98036 | 01 | FL | BCBSFL GROUP NUMBER | OTHER |