Provider Demographics
NPI:1568750933
Name:COLOMBO, DANIEL T (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:COLOMBO
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 1:9679 LAKE NONA VILLAGE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7310
Mailing Address - Country:US
Mailing Address - Phone:407-261-2934
Mailing Address - Fax:407-636-7811
Practice Address - Street 1:9679 LAKE NONA VILLAGE PL STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7310
Practice Address - Country:US
Practice Address - Phone:407-261-2934
Practice Address - Fax:407-636-7811
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9889208000000X
FLME149568208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115987800Medicaid