Provider Demographics
NPI:1528459856
Name:MARIA T. POL-CARBALLO, MD PA
Entity type:Organization
Organization Name:MARIA T. POL-CARBALLO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:POL-CARBALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:305-820-6999
Mailing Address - Street 1:6450 W 21ST CT
Mailing Address - Street 2:SUITE #301
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3946
Mailing Address - Country:US
Mailing Address - Phone:305-820-6999
Mailing Address - Fax:305-820-9279
Practice Address - Street 1:6450 W 21ST CT
Practice Address - Street 2:SUITE #301
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3946
Practice Address - Country:US
Practice Address - Phone:305-820-6999
Practice Address - Fax:305-820-9279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00606042080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0060604OtherFLORIDA LICENSE
FL372237600Medicaid
E34645Medicare UPIN