MEDICARE: GIRALDO E CEPEDA MD PA

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	208000000X	Pediatrics Physician	ME0058912	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

General Provider Information

NPI Number	:	1538335856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIRALDO E CEPEDA MD PA

Provider Business Mailing Address
First Line	:	1221 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4707
Country	:	US
Telephone Number	:	772-467-6587
Fax Number	:	772-466-4297

Provider Business Practice Location Address
First Line	:	1221 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4707
Country	:	US
Telephone Number	:	772-467-6587
Fax Number	:	772-466-4297

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GIRALDO ENRIQUE CEPEDA
Credential	:	MD
Telephone Number	:	772-467-6587

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/07/2008

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