Provider Demographics
NPI:1558558866
Name:CARL SUCHAR DO PA
Entity Type:Organization
Organization Name:CARL SUCHAR DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-441-1451
Mailing Address - Street 1:613 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5615
Mailing Address - Country:US
Mailing Address - Phone:727-441-1451
Mailing Address - Fax:727-446-9528
Practice Address - Street 1:613 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5615
Practice Address - Country:US
Practice Address - Phone:727-441-1451
Practice Address - Fax:727-446-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263318300Medicaid
FL263318300Medicaid
FLK2790Medicare PIN