Provider Demographics
NPI:1205874039
Name:FIORENTINO, CARMINE (MD)
Entity type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:
Last Name:FIORENTINO
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:P O BOX 577
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-0577
Mailing Address - Country:US
Mailing Address - Phone:864-985-1122
Mailing Address - Fax:864-985-1817
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3245
Practice Address - Country:US
Practice Address - Phone:864-985-1122
Practice Address - Fax:864-985-1817
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2702 189593Medicaid
SCG36704Medicare UPIN