Provider Demographics
NPI:1316032923
Name:OLMEDA, MARIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
Last Name:OLMEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1542 KINGSLEY AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4586
Mailing Address - Country:US
Mailing Address - Phone:904-579-3189
Mailing Address - Fax:904-458-4054
Practice Address - Street 1:1542 KINGSLEY AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4586
Practice Address - Country:US
Practice Address - Phone:904-579-3189
Practice Address - Fax:904-458-4054
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401107207RG0100X
NM2001-275207RG0100X
FLME122386207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000G262Medicaid
NC891374HMedicaid
AZ839467OtherAHCCCS
FL014961100Medicaid
NC1374HOtherBLUE CROSS BLUE SHEILD
FLII832YMedicare PIN
NM000G262Medicaid