Healthcare Provider Details

I. General information

NPI: 1578540142
Provider Name (Legal Business Name): CHARLES E. GARRAMONE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 SW 148TH AVE STE 202
DAVIE FL
33330-2124
US

IV. Provider business mailing address

12651 W SUNRISE BLVD SUITE 102
SUNRISE FL
33323-0906
US

V. Phone/Fax

Practice location:
  • Phone: 954-752-7842
  • Fax: 954-473-2454
Mailing address:
  • Phone: 954-752-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number9076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: