Provider Demographics
NPI:1235221607
Name:PEZZULLO, ROSEMARIE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:ANNE
Last Name:PEZZULLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 CREEKSIDE PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1946
Mailing Address - Country:US
Mailing Address - Phone:239-658-3712
Mailing Address - Fax:239-591-4393
Practice Address - Street 1:1265 CREEKSIDE PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1946
Practice Address - Country:US
Practice Address - Phone:239-658-3712
Practice Address - Fax:239-591-4393
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226615208000000X
FLME126917208000000X
TXP3222208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018759200Medicaid
NY02360305Medicaid