Provider Demographics
NPI:1437382421
Name:DONATO A VIGGIANO MD PA
Entity Type:Organization
Organization Name:DONATO A VIGGIANO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONATO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VIGGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-335-3954
Mailing Address - Street 1:1901 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5582
Mailing Address - Country:US
Mailing Address - Phone:772-335-3954
Mailing Address - Fax:772-335-8379
Practice Address - Street 1:1901 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5582
Practice Address - Country:US
Practice Address - Phone:772-335-3954
Practice Address - Fax:772-335-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067096100Medicaid
FLD62447Medicare UPIN
FL7-43082Medicare PIN