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General NPI Number Information
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NPI Number | 1962463802
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Entity Type | Individual
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Provider Name | PEDRO A CARMONA MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 951 N WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32796-2163
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Country | US
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Telephone | 321-268-6111
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Fax | 321-268-6149
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Provider Business Mailing Address
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Address Line | 3450 BUSCHWOOD PARK DR SUITE 150
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City | TAMPA
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State | FL
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Zip | 33618-4465
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Country | US
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Telephone | 813-935-8501
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Fax | 813-935-8541
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME42901
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License Number State | FL
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