MEDICARE: MR. MICHAEL ANTHONY CAROMANO PA-C

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	363A00000X	Physician Assistant	25MP00130300	NJ

General Provider Information

NPI Number	:	1912931569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY CAROMANO PA-C

Provider Business Mailing Address
First Line	:	609 LAZY LN
Second Line	:
City	:	ABSECON
State	:	NJ
Zip	:	08201-1317
Country	:	US
Telephone Number	:	609-206-1505
Fax Number	:

Provider Business Practice Location Address
First Line	:	4248 HARBOUR BEACH BLVD
Second Line	:
City	:	BRIGANTINE
State	:	NJ
Zip	:	08203-1361
Country	:	US
Telephone Number	:	609-266-0400
Fax Number	:	609-948-3047

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/13/2007

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