Provider Demographics
NPI:1134296296
Name:PIETRA, BIAGIO (MD)
Entity Type:Individual
Prefix:
First Name:BIAGIO
Middle Name:
Last Name:PIETRA
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 1:1600 SW ARCHER RD # 100297
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0297
Mailing Address - Country:US
Mailing Address - Phone:352-273-5422
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD # 100297
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0297
Practice Address - Country:US
Practice Address - Phone:352-273-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1199372080P0202X
CO339962080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012301800Medicaid
CO01339969Medicaid
FLHX498ZMedicare PIN
FL012301800Medicaid