Provider Demographics
NPI:1659642239
Name:HECTOR DI CARLO, MD, PA
Entity Type:Organization
Organization Name:HECTOR DI CARLO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:DI CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-309-7099
Mailing Address - Street 1:4850 NE 25TH AVE
Mailing Address - Street 2:HOUSE A
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4813
Mailing Address - Country:US
Mailing Address - Phone:954-309-7099
Mailing Address - Fax:
Practice Address - Street 1:7710 NW 71ST CT
Practice Address - Street 2:SUITE 304
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2973
Practice Address - Country:US
Practice Address - Phone:954-309-7099
Practice Address - Fax:954-721-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty