Provider Demographics
NPI:1275512295
Name:OLIVA, ARCADIO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ARCADIO
Middle Name:J
Last Name:OLIVA
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:PO BOX 537046
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-7046
Mailing Address - Country:US
Mailing Address - Phone:912-261-2669
Mailing Address - Fax:912-261-0561
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:912-261-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041969207ZP0102X
FLME53804207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262599700Medicaid
FL262599700Medicaid
FL08643UMedicare PIN
FL08643VMedicare PIN
FL08643XMedicare PIN
FL262599700Medicaid
FL08643YMedicare PIN