Healthcare Provider Details

I. General information

NPI: 1659606606
Provider Name (Legal Business Name): CAROLYN M. CAREY, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 BRUCE B DOWNS BLVD
TAMPA FL
33612-9201
US

IV. Provider business mailing address

601 5TH ST S SUITE 511
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8181
  • Fax:
Mailing address:
  • Phone: 727-767-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLYN M CAREY
Title or Position: PRESIDENT
Credential: MD
Phone: 727-767-8181