Provider Demographics
NPI:1588656698
Name:GUARINO, CARL P (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:P
Last Name:GUARINO
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16511 BERWICK TER
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-5292
Practice Address - Country:US
Practice Address - Phone:315-415-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203277207Y00000X, 2085R0202X
IN01088921A207Y00000X, 2085R0202X
FLME1493742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00555500Medicaid
NY01827509Medicaid
NY00555440Medicaid
NY02224500Medicaid
CC0680Medicare PIN
NY00555500Medicaid
NY00555440Medicaid
NY01827509Medicaid
CC4349Medicare PIN
AA0672Medicare PIN
34589AMedicare PIN