Provider Demographics
NPI:1912075755
Name:CARROZZELLA, JOHN C II (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:CARROZZELLA
Suffix:II
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 1:7575 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7216
Mailing Address - Country:US
Mailing Address - Phone:407-507-3837
Mailing Address - Fax:407-507-3841
Practice Address - Street 1:7575 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7216
Practice Address - Country:US
Practice Address - Phone:407-507-3837
Practice Address - Fax:407-507-3841
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME589082083P0901X, 208VP0000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064698901Medicaid
FL064698901Medicaid
FLC03203Medicare UPIN