Provider Demographics
NPI:1982866182
Name:KERSHBAUM, CAROL M (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:KERSHBAUM
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 1:1211 E CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4231
Mailing Address - Country:US
Mailing Address - Phone:813-412-7667
Mailing Address - Fax:
Practice Address - Street 1:1211 E CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4231
Practice Address - Country:US
Practice Address - Phone:813-412-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME050030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE75857Medicare UPIN