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General NPI Number Information
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NPI Number | 1538300348
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Entity Type | Organization
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Legal Business Name | THOMAS J. FEDERICO MD LLC
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 600 N. HART BLVD
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City | ORLANDO
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State | FL
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Zip | 32818-6834
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Country | US
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Telephone | 407-297-0087
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Fax | 407-290-1753
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Provider Business Mailing Address
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Address Line | 600 N. HART BLVD
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City | ORLANDO
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State | FL
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Zip | 32818-6834
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Country | US
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Telephone | 407-297-0087
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Fax | 407-290-1753
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | THOMAS JOSEPH FEDERICO
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Credential | M.D.
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Telephone | 407-297-0087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME0047275
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License Number State | FL
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