1356301733 NPI number — DR. RICHARD RAYMOND CARADONNA M.D.

Table of content: DR. RICHARD RAYMOND CARADONNA M.D. (NPI 1356301733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356301733 NPI number — DR. RICHARD RAYMOND CARADONNA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARADONNA
Provider First Name:
RICHARD
Provider Middle Name:
RAYMOND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356301733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14690 SPRING HILL DR
Provider Second Line Business Mailing Address:
STE 101 ATTN:CREDENTIALING
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-799-0046
Provider Business Mailing Address Fax Number:
352-606-2857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11373 CORTEZ BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-597-4998
Provider Business Practice Location Address Fax Number:
352-596-6051
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  ME49404 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 064662800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09441 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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