Provider Demographics
NPI:1477595361
Name:COSENTINO, GERALD LOUIS (DPM)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:LOUIS
Last Name:COSENTINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-877-6636
Mailing Address - Fax:813-877-6610
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-877-6636
Practice Address - Fax:813-877-6610
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-0001221213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041093400Medicaid
FL041093400Medicaid
FLT95171Medicare UPIN
FL0727650001Medicare NSC