Provider Demographics
NPI:1437127685
Name:DEISLER, PATRICIA C (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:DEISLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:C
Other - Last Name:GEORGE-DEISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:95 BULLDOG BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3188
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:845 CENTURY MEDICAL DR STE B
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2157
Practice Address - Country:US
Practice Address - Phone:321-529-6202
Practice Address - Fax:321-802-6864
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD203562207RX0202X
FLME13887207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432033699Medicaid
NH30205972Medicaid
WA2030128Medicaid
MEVX0888Medicare PIN
F54509Medicare UPIN
ME432033699Medicaid