MEDICARE: DR. CHARLES E. GARRAMONE D.O.

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	208200000X	Plastic Surgery Physician	9076	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-2634512	OTHER	FL	TAX-ID

General Provider Information

NPI Number	:	1578540142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E. GARRAMONE D.O.

Provider Business Mailing Address
First Line	:	12651 W SUNRISE BLVD
Second Line	:	SUITE 102
City	:	SUNRISE
State	:	FL
Zip	:	33323-0906
Country	:	US
Telephone Number	:	954-752-7842
Fax Number	:

Provider Business Practice Location Address
First Line	:	4725 SW 148TH AVE STE 202
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-2124
Country	:	US
Telephone Number	:	954-752-7842
Fax Number	:	954-473-2454

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	10/29/2019

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