Provider Demographics
NPI:1083607402
Name:DIGIAMBERARDINO, ADRIANO (DO)
Entity Type:Individual
Prefix:DR
First Name:ADRIANO
Middle Name:
Last Name:DIGIAMBERARDINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4477
Mailing Address - Country:US
Mailing Address - Phone:954-456-1212
Mailing Address - Fax:954-458-4079
Practice Address - Street 1:800 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 22
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4477
Practice Address - Country:US
Practice Address - Phone:954-456-1212
Practice Address - Fax:954-458-4079
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG11169Medicare UPIN
FL57181BMedicare ID - Type Unspecified