Provider Demographics
NPI:1699019315
Name:BAY AREA ENDOCRINOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:BAY AREA ENDOCRINOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-876-3636
Mailing Address - Street 1:4816 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1400
Mailing Address - Country:US
Mailing Address - Phone:813-876-3636
Mailing Address - Fax:813-870-0077
Practice Address - Street 1:4816 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-876-3636
Practice Address - Fax:813-870-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94508207RE0101X
FLME97850207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGX150AMedicare PIN