Provider Demographics
NPI:1598792848
Name:SCARZELLA, DAWN MARIA (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIA
Last Name:SCARZELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1725 N UNIVERSITY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6089
Practice Address - Country:US
Practice Address - Phone:954-752-3166
Practice Address - Fax:954-753-5628
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076629174400000X
FLME76629208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44213OtherBCBS
FL8255OtherDIMENSION HEALTH
FL262218100Medicaid
FLP971118OtherOPTIMUM
FL9520355OtherCIGNA
FLQMP00003937505OtherMOLINA
FLP01604626OtherRR MEDICARE
FLP02352OtherFREEDOM
FL251244OtherAVMED
FL5919714OtherAETNA
FLP971118OtherOPTIMUM
FLP02352OtherFREEDOM
FLG79737Medicare UPIN