Provider Demographics
NPI:1487631834
Name:CENNAMO, JAMES A (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:CENNAMO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 NE 27TH DR
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4354
Mailing Address - Country:US
Mailing Address - Phone:954-565-4974
Mailing Address - Fax:
Practice Address - Street 1:2708 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1605
Practice Address - Country:US
Practice Address - Phone:954-318-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF45811Medicare UPIN
FLK6663Medicare ID - Type Unspecified