Provider Demographics
NPI:1174639348
Name:EBURUCHE, CARMELITA CHINYERE (MD)
Entity type:Individual
Prefix:
First Name:CARMELITA
Middle Name:CHINYERE
Last Name:EBURUCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 ROLLING ACRES RD
Mailing Address - Street 2:SUITE #8
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5027
Mailing Address - Country:US
Mailing Address - Phone:352-750-6358
Mailing Address - Fax:352-750-6329
Practice Address - Street 1:918 ROLLING ACRES RD
Practice Address - Street 2:SUITE #8
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5027
Practice Address - Country:US
Practice Address - Phone:352-750-6358
Practice Address - Fax:352-750-6329
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00415689OtherRAILROAD MEDICARE
FL42639AMedicare ID - Type Unspecified
FLAB780Medicare PIN
FL42639ZMedicare UPIN
FLG50696Medicare UPIN