Provider Demographics
NPI:1962463802
Name:CARMONA, PEDRO A (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:A
Last Name:CARMONA
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 1:3450 BUSCHWOOD PARK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4465
Mailing Address - Country:US
Mailing Address - Phone:813-935-8501
Mailing Address - Fax:813-935-8541
Practice Address - Street 1:951 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2163
Practice Address - Country:US
Practice Address - Phone:321-268-6111
Practice Address - Fax:321-268-6149
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42901207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006302300Medicaid
FL006302300Medicaid
FL04341ZMedicare PIN