Provider Demographics
NPI:1689657868
Name:CRESPO, CARMELO A (MD)
Entity Type:Individual
Prefix:
First Name:CARMELO
Middle Name:A
Last Name:CRESPO
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:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0687
Mailing Address - Country:US
Mailing Address - Phone:787-796-3466
Mailing Address - Fax:787-796-3466
Practice Address - Street 1:338 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4908
Practice Address - Country:US
Practice Address - Phone:787-796-3466
Practice Address - Fax:787-796-3466
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5017207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine