Provider Demographics
NPI:1265620744
Name:SUNTREE MEDICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:SUNTREE MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:SALADINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-757-9711
Mailing Address - Street 1:6420 3RD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5788
Mailing Address - Country:US
Mailing Address - Phone:321-757-9711
Mailing Address - Fax:321-253-1675
Practice Address - Street 1:6420 3RD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5788
Practice Address - Country:US
Practice Address - Phone:321-757-9711
Practice Address - Fax:321-253-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 55132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21863Medicare PIN