Provider Demographics
NPI:1356301733
Name:CARADONNA, RICHARD RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAYMOND
Last Name:CARADONNA
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 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 101 ATTN:CREDENTIALING
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-597-4998
Practice Address - Fax:352-596-6051
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49404207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064662800Medicaid
FL09441OtherBLUE CROSS BLUE SHIELD
FLP01158461OtherRAILROAD MEDICARE
B82232Medicare UPIN
FL09441KMedicare PIN
FL064662800Medicaid
FL09441IMedicare PIN
FL09441JMedicare PIN