Provider Demographics
NPI:1114114170
Name:DRAGO, JOSEPH ROSARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROSARIO
Last Name:DRAGO
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 1:6680 MOSSY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4722
Mailing Address - Country:US
Mailing Address - Phone:239-826-2151
Mailing Address - Fax:239-362-1198
Practice Address - Street 1:10,000 BAY PINES BLVD.
Practice Address - Street 2:
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:239-826-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05866800208800000X
PAMD014747E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6100813Medicaid
PA00666696Medicaid
NJ6100813Medicaid