Provider Demographics
NPI:1083712418
Name:CONNELLY, CAROLYN SCHROEDER (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:SCHROEDER
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2919 W SWANN AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4052
Mailing Address - Country:US
Mailing Address - Phone:813-870-2100
Mailing Address - Fax:813-870-2125
Practice Address - Street 1:2919 W SWANN AVE STE 404
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4052
Practice Address - Country:US
Practice Address - Phone:813-870-2100
Practice Address - Fax:813-870-2125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL51168207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08533Medicare UPIN