1528058682 NPI number — THEODORE YAREMO MD PA

Table of content: (NPI 1528058682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528058682 NPI number — THEODORE YAREMO MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THEODORE YAREMO MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1528058682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 W MARION AVE
Provider Second Line Business Mailing Address:
SUTIE 118
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33950-5372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-637-6062
Provider Business Mailing Address Fax Number:
941-575-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 W MARION AVE
Provider Second Line Business Practice Location Address:
SUTIE 118
Provider Business Practice Location Address City Name:
PUNTA GORDA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33950-5372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-637-6062
Provider Business Practice Location Address Fax Number:
941-575-4449
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
YAREMO
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
941-637-6062

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , 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: 74616 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com