Provider Demographics
NPI:1902994460
Name:PEDEN, CARMEN (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:PEDEN
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6328
Mailing Address - Country:US
Mailing Address - Phone:813-875-8032
Mailing Address - Fax:813-875-0227
Practice Address - Street 1:2716 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6328
Practice Address - Country:US
Practice Address - Phone:813-875-8032
Practice Address - Fax:813-875-0227
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107458207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 107458OtherFLORIDA MEDICAL LICENSE NUMBER
FLME 107458OtherFLORIDA MEDICAL LICENSE NUMBER