MEDICARE: DR. BERNADETTE CAROL PROFETA M.D.

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	208600000X	Surgery Physician	MD069235L	PA
2	208600000X	Surgery Physician	25MA08750100	NJ
3	208600000X	Surgery Physician	ME120470	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477579837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNADETTE CAROL PROFETA M.D.

Provider Business Mailing Address
First Line	:	258 S CHICKASAW TRL STE 301
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3501
Country	:	US
Telephone Number	:	407-303-7399
Fax Number	:	407-303-7305

Provider Business Practice Location Address
First Line	:	258 S CHICKASAW TRL STE 301
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3501
Country	:	US
Telephone Number	:	407-303-7399
Fax Number	:	407-303-7305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	02/18/2021

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Directions to “ DR. BERNADETTE CAROL PROFETA M.D.” Practice Location

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