Healthcare Provider Details

I. General information

NPI: 1568750933
Provider Name (Legal Business Name): DANIEL T COLOMBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9679 LAKE NONA VILLAGE PL STE 101
ORLANDO FL
32827-7310
US

IV. Provider business mailing address

9679 LAKE NONA VILLAGE PL STE 101
ORLANDO FL
32827-7310
US

V. Phone/Fax

Practice location:
  • Phone: 407-261-2934
  • Fax: 407-636-7811
Mailing address:
  • Phone: 407-261-2934
  • Fax: 407-636-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9889
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME149568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: