Provider Demographics
NPI:1073765855
Name:CARMEN A COISCOU MD PA
Entity Type:Organization
Organization Name:CARMEN A COISCOU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COISCOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-782-2100
Mailing Address - Street 1:8330 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5174
Mailing Address - Country:US
Mailing Address - Phone:941-782-2100
Mailing Address - Fax:941-706-2107
Practice Address - Street 1:8330 LAKEWOOD RANCH BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-5174
Practice Address - Country:US
Practice Address - Phone:941-782-2100
Practice Address - Fax:941-706-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-11
Last Update Date:2008-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94475208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277343100Medicaid
FLU7038YMedicare UPIN