Provider Demographics
NPI:1043208333
Name:PANTALEON, MARIA C (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:PANTALEON
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 1:1840 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-2138
Mailing Address - Country:US
Mailing Address - Phone:727-442-3001
Mailing Address - Fax:727-467-9106
Practice Address - Street 1:1840 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2138
Practice Address - Country:US
Practice Address - Phone:727-442-3001
Practice Address - Fax:727-467-9106
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0078640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110223667OtherRAILROAD MEDICARE
FL257551500Medicaid
FL35306OtherBC FLORIDA
FLE31952Medicare ID - Type Unspecified
FL257551500Medicaid