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General NPI Number Information
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NPI Number | 1285848572
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Entity Type | Organization
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Legal Business Name | EDWARD CARVALLO MD PA PLASTIC & HAND SURGERY
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 106 HOMEPORT DR
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City | PALM HARBOR
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State | FL
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Zip | 34683-5409
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Country | US
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Telephone | 727-919-2395
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Fax |
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Provider Business Mailing Address
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Address Line | 106 HOMEPORT DR
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City | PALM HARBOR
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State | FL
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Zip | 34683-5409
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Country | US
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Telephone | 727-919-2395
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. EDWARD CARVALLO
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Credential | MD
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Telephone | 727-919-2395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 879
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License Number State | FL
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