Healthcare Provider Details

I. General information

NPI: 1891795357
Provider Name (Legal Business Name): CELIA P DI MARCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 S FORT HARRISON AVE
CLEARWATER FL
33756-3907
US

IV. Provider business mailing address

1105 S FORT HARRISON AVE
CLEARWATER FL
33756-3907
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-3163
  • Fax: 727-461-4037
Mailing address:
  • Phone: 727-461-3163
  • Fax: 727-461-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 40031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: