Provider Demographics
NPI:1225370984
Name:MARCONI, DAVID FITZGERALD (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FITZGERALD
Last Name:MARCONI
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 1:6160 WINKLER RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8179
Mailing Address - Country:US
Mailing Address - Phone:239-362-3005
Mailing Address - Fax:239-362-3392
Practice Address - Street 1:6160 WINKLER RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8179
Practice Address - Country:US
Practice Address - Phone:239-362-3005
Practice Address - Fax:239-362-3392
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134109208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101738300Medicaid