Provider Demographics
NPI:1508273111
Name:DIIENNO, DONALD ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ANTHONY
Last Name:DIIENNO
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 1:4625 E BAY DR
Mailing Address - Street 2:SUITE 314
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-5738
Mailing Address - Country:US
Mailing Address - Phone:727-725-3555
Mailing Address - Fax:727-725-2923
Practice Address - Street 1:4625 E BAY DR
Practice Address - Street 2:SUITE 314
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-5738
Practice Address - Country:US
Practice Address - Phone:727-725-3555
Practice Address - Fax:727-725-2923
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40320207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85547Medicare UPIN