Provider Demographics
NPI:1053322511
Name:BERLET, CAROL LASCH (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LASCH
Last Name:BERLET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16205 TALAVERA DE AVILA
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-5210
Mailing Address - Country:US
Mailing Address - Phone:813-961-7873
Mailing Address - Fax:
Practice Address - Street 1:6001 WEBB RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3241
Practice Address - Country:US
Practice Address - Phone:913-754-0467
Practice Address - Fax:913-341-5797
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65321207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25069OtherBCBS
FL374925800Medicaid
FL374925800Medicaid
FL374925800Medicaid
FL25069OtherBCBS
FL25069WMedicare PIN