Provider Demographics
NPI:1437152824
Name:LAGANELLA, VINCENT A (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:LAGANELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743409
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3409
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-532-1325
Practice Address - Street 1:10141 BIG BEND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7419
Practice Address - Country:US
Practice Address - Phone:813-397-1270
Practice Address - Fax:813-397-1271
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260017000Medicaid
FLH18297Medicare UPIN
FL35272ZMedicare PIN