Provider Demographics
NPI:1881054559
Name:CONCORDE, CAROL J
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:J
Last Name:CONCORDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 RYMSHAW DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6459
Mailing Address - Country:US
Mailing Address - Phone:386-437-4977
Mailing Address - Fax:
Practice Address - Street 1:84 RYMSHAW DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6459
Practice Address - Country:US
Practice Address - Phone:386-437-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder