Provider Demographics
NPI:1508113895
Name:CARCAMO PEDIATRICS, INC
Entity Type:Organization
Organization Name:CARCAMO PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:CARCAMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-366-4040
Mailing Address - Street 1:7560 RED BUG LAKE RD
Mailing Address - Street 2:SUITE 1070
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6591
Mailing Address - Country:US
Mailing Address - Phone:407-366-4040
Mailing Address - Fax:407-366-0025
Practice Address - Street 1:7560 RED BUG LAKE RD
Practice Address - Street 2:SUITE 1070
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6591
Practice Address - Country:US
Practice Address - Phone:407-366-4040
Practice Address - Fax:407-366-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278948500Medicaid