Provider Demographics
NPI:1962846196
Name:BLANQUICETT, CARMELO J (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMELO
Middle Name:J
Last Name:BLANQUICETT
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6499 38TH AVE N STE G1
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1658
Mailing Address - Country:US
Mailing Address - Phone:727-381-3761
Mailing Address - Fax:
Practice Address - Street 1:6499 38TH AVE N STE G1
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1658
Practice Address - Country:US
Practice Address - Phone:727-381-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL160693207RH0003X
GA78600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine