Provider Demographics
NPI:1235257668
Name:GADEA, CARLOS ACEVEDO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ACEVEDO
Last Name:GADEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 LUCERNE TERRACE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1013
Mailing Address - Country:US
Mailing Address - Phone:407-426-8660
Mailing Address - Fax:407-839-1426
Practice Address - Street 1:922 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1013
Practice Address - Country:US
Practice Address - Phone:407-426-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231968208M00000X
FLME120736207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00435673OtherRR MEDICARE