Provider Demographics
NPI:1689613010
Name:DAMIANI, CARMEN R (DO PA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:R
Last Name:DAMIANI
Suffix:
Gender:F
Credentials:DO PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 SEMINOLE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2539
Mailing Address - Country:US
Mailing Address - Phone:727-397-8888
Mailing Address - Fax:727-399-9828
Practice Address - Street 1:10011 SEMINOLE BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2539
Practice Address - Country:US
Practice Address - Phone:727-397-8888
Practice Address - Fax:727-399-9828
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4399207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047757500Medicaid
FL82455Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL047757500Medicaid