Provider Demographics
NPI:1538300348
Name:THOMAS J. FEDERICO MD LLC
Entity Type:Organization
Organization Name:THOMAS J. FEDERICO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FEDERICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-297-0087
Mailing Address - Street 1:600 N. HART BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-6834
Mailing Address - Country:US
Mailing Address - Phone:407-297-0087
Mailing Address - Fax:407-290-1753
Practice Address - Street 1:600 N. HART BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6834
Practice Address - Country:US
Practice Address - Phone:407-297-0087
Practice Address - Fax:407-290-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047275261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB84836Medicare UPIN