Provider Demographics
NPI:1710188313
Name:CAROLYN M. CAREY, MD, PA
Entity Type:Organization
Organization Name:CAROLYN M. CAREY, MD, PA
Other - Org Name:CENTER FOR PEDIATRIC NEUROSURGERY & NEUROSCIENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-767-3808
Mailing Address - Street 1:601 5TH ST S
Mailing Address - Street 2:SUITE 511
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-8181
Mailing Address - Fax:727-767-8030
Practice Address - Street 1:3310 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1974
Practice Address - Country:US
Practice Address - Phone:727-767-8181
Practice Address - Fax:727-767-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273786801Medicaid