MEDICARE: CARECONNECTMD PENNSYLVANIA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1356170708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARECONNECTMD PENNSYLVANIA PC

Provider Business Mailing Address
First Line	:	3090 BRISTOL ST STE 200
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-3061
Country	:	US
Telephone Number	:	888-789-9585
Fax Number	:	562-803-4500

Provider Business Practice Location Address
First Line	:	2395 LANCASTER PIKE FL 1
Second Line	:
City	:	READING
State	:	PA
Zip	:	19607-2375
Country	:	US
Telephone Number	:	888-789-9585
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ORLANDO COLLADO
Credential	:	MD
Telephone Number	:	714-514-6118

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	08/01/2024

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