Provider Demographics
NPI:1720078553
Name:BAMBA DAGANI, CARMELITA (MD)
Entity Type:Individual
Prefix:
First Name:CARMELITA
Middle Name:
Last Name:BAMBA DAGANI
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 1:500 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4906
Mailing Address - Country:US
Mailing Address - Phone:407-935-1060
Mailing Address - Fax:407-933-1703
Practice Address - Street 1:1825 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1853
Practice Address - Country:US
Practice Address - Phone:407-206-2375
Practice Address - Fax:407-206-2377
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAME33174207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49047Medicare ID - Type Unspecified