Provider Demographics
NPI:1982695516
Name:SUCHAR, CARL (DO)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:SUCHAR
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 1:613 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5615
Mailing Address - Country:US
Mailing Address - Phone:727-441-1451
Mailing Address - Fax:727-446-9528
Practice Address - Street 1:613 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5615
Practice Address - Country:US
Practice Address - Phone:727-441-1451
Practice Address - Fax:727-446-9528
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068957200Medicaid
FL82634YMedicare PIN
FL068957200Medicaid