Healthcare Provider Details

I. General information

NPI: 1356170708
Provider Name (Legal Business Name): CARECONNECTMD PENNSYLVANIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 LANCASTER PIKE FL 1
READING PA
19607-2375
US

IV. Provider business mailing address

3090 BRISTOL ST STE 200
COSTA MESA CA
92626-3061
US

V. Phone/Fax

Practice location:
  • Phone: 888-789-9585
  • Fax:
Mailing address:
  • Phone: 888-789-9585
  • Fax: 562-803-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ORLANDO COLLADO
Title or Position: OWNER
Credential: MD
Phone: 714-514-6118