Provider Demographics
NPI:1306800024
Name:PAYUMO, CARMELINO C (MD)
Entity type:Individual
Prefix:
First Name:CARMELINO
Middle Name:C
Last Name:PAYUMO
Suffix:
Gender:M
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:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-0387
Mailing Address - Country:US
Mailing Address - Phone:732-826-4177
Mailing Address - Fax:732-607-1160
Practice Address - Street 1:205 MAY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3267
Practice Address - Country:US
Practice Address - Phone:732-661-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA29026207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1297805Medicaid
F06826Medicare UPIN
NJ1297805Medicaid