MEDICARE: PEDRO A CARMONA MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME42901	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	:	1962463802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO A CARMONA MD

Provider Business Mailing Address
First Line	:	3450 BUSCHWOOD PARK DR
Second Line	:	SUITE 150
City	:	TAMPA
State	:	FL
Zip	:	33618-4465
Country	:	US
Telephone Number	:	813-935-8501
Fax Number	:	813-935-8541

Provider Business Practice Location Address
First Line	:	951 N WASHINGTON AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2163
Country	:	US
Telephone Number	:	321-268-6111
Fax Number	:	321-268-6149

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	09/27/2019

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Directions to “ PEDRO A CARMONA MD” Practice Location

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