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General NPI Number Information
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NPI Number | 1578752523
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Entity Type | Organization
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Legal Business Name | CLERMONT CARDIOLOGY PA
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 200 E HIGHLAND AVE STE 1
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City | CLERMONT
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State | FL
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Zip | 34711-2582
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Country | US
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Telephone | 352-394-3611
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Fax | 352-394-0739
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Provider Business Mailing Address
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Address Line | 200 E HIGHLAND AVE STE 1
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City | CLERMONT
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State | FL
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Zip | 34711-2582
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Country | US
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Telephone | 352-394-3611
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Fax | 352-394-0739
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BARBARA A STONE
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Credential |
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Telephone | 352-394-3611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME0057361
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License Number State | FL
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