Provider Demographics
NPI:1073516811
Name:MAIELLO, ROBERT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:MAIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 223730
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-0001
Mailing Address - Country:US
Mailing Address - Phone:352-273-9860
Mailing Address - Fax:352-294-8035
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-273-9860
Practice Address - Fax:352-294-8035
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60568208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593656451OtherUNITEDHEALTHCARE
FL12890OtherBLUE CROSS BLUE SHEILD
FL5700283OtherAETNA
FL05606690Medicaid
FL250011577OtherPALMETTO GBA RAILROAD MCR
12890ZMedicare PIN
FL593656451OtherUNITEDHEALTHCARE