Provider Demographics
NPI:1710918966
Name:DEGUZMAN, CARMELITA T (MD)
Entity Type:Individual
Prefix:
First Name:CARMELITA
Middle Name:T
Last Name:DEGUZMAN
Suffix:
Gender:F
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 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-728-2000
Mailing Address - Fax:215-214-4119
Practice Address - Street 1:7600 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2442
Practice Address - Country:US
Practice Address - Phone:215-728-2000
Practice Address - Fax:215-214-4119
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037835L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherRAIL ROAD MEDICARE GROUP TPI
PA1007278000OtherMEDICAID GROUP TPI
PA597586OtherMEDICARE GROUP TPI
PA1007278000OtherMEDICAID GROUP TPI