Provider Demographics
NPI:1194852657
Name:J. PAONESSA M.D. P.A.
Entity Type:Organization
Organization Name:J. PAONESSA M.D. P.A.
Other - Org Name:GULFCOAST ONCOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CIARROCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-824-4601
Mailing Address - Street 1:1201 5TH AVE N
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1455
Mailing Address - Country:US
Mailing Address - Phone:727-821-0017
Mailing Address - Fax:727-502-8860
Practice Address - Street 1:1615 PASADENA AVE S
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4516
Practice Address - Country:US
Practice Address - Phone:727-341-1316
Practice Address - Fax:727-345-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376230100Medicaid
FL33119Medicare PIN