Provider Demographics
NPI:1285848572
Name:EDWARD CARVALLO MD PA PLASTIC & HAND SURGERY
Entity Type:Organization
Organization Name:EDWARD CARVALLO MD PA PLASTIC & HAND SURGERY
Other - Org Name:SUNCOAST OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-919-2395
Mailing Address - Street 1:106 HOMEPORT DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5409
Mailing Address - Country:US
Mailing Address - Phone:727-919-2395
Mailing Address - Fax:
Practice Address - Street 1:106 HOMEPORT DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5409
Practice Address - Country:US
Practice Address - Phone:727-919-2395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL879261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF-1158Medicare ID - Type UnspecifiedMEDICARE PRIVIDER