Provider Demographics
NPI:1518204619
Name:ANTHONY D'AGOSTINO MD PA
Entity Type:Organization
Organization Name:ANTHONY D'AGOSTINO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AGOSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-262-6111
Mailing Address - Street 1:1350 9TH ST N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5209
Mailing Address - Country:US
Mailing Address - Phone:239-262-6111
Mailing Address - Fax:239-435-3920
Practice Address - Street 1:1350 9TH ST N
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5209
Practice Address - Country:US
Practice Address - Phone:239-262-6111
Practice Address - Fax:239-435-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066399261QP2300X
FL10D0944089291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG29591Medicare UPIN