MEDICARE: THOMAS NEIL CARMENA 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	207RC0000X	Cardiovascular Disease Physician	2030	NV

General Provider Information

NPI Number	:	1700078037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS NEIL CARMENA M,D.

Provider Business Mailing Address
First Line	:	2825 PINTO LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-4618
Country	:	US
Telephone Number	:	702-878-8108
Fax Number	:	702-878-8108

Provider Business Practice Location Address
First Line	:	2250 S RANCHO DR
Second Line	:	SUITE 225
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4451
Country	:	US
Telephone Number	:	702-878-8108
Fax Number	:	702-878-8108

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	08/10/2007

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