Provider Demographics
NPI:1598810343
Name:PACITTI, ANTHONY J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:PACITTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:J
Other - Last Name:PACITTI, MD, PA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PA
Mailing Address - Street 1:PO BOX 850001
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0192
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-1550
Practice Address - Street 1:205 ZEAGLER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3888
Practice Address - Country:US
Practice Address - Phone:386-312-8519
Practice Address - Fax:386-312-8523
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78644208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47079OtherBLUE SHIELD
FL256869100Medicaid
FL020046738OtherRAILROAD MEDICARE
FL256869100Medicaid
FL47079YMedicare PIN