Provider Demographics
NPI:1780813865
Name:PONTI, CARLO (DO)
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:PONTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 NW 91ST WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1908
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-839-2569
Practice Address - Street 1:4823 NW 91ST WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-1908
Practice Address - Country:US
Practice Address - Phone:954-702-9672
Practice Address - Fax:954-702-9672
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018432207L00000X
FLOS12336207L00000X
NVDO1641207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology