Healthcare Provider Details

I. General information

NPI: 1356301733
Provider Name (Legal Business Name): RICHARD RAYMOND CARADONNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11373 CORTEZ BLVD SUITE 200
BROOKSVILLE FL
34613
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 101 ATTN:CREDENTIALING
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-4998
  • Fax: 352-596-6051
Mailing address:
  • Phone: 352-799-0046
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME49404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: