Provider Demographics
NPI:1609934850
Name:RICHARD DEGREGORIO MD P A
Entity Type:Organization
Organization Name:RICHARD DEGREGORIO MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGREGORIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-545-2339
Mailing Address - Street 1:8455 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-1206
Mailing Address - Country:US
Mailing Address - Phone:727-545-2339
Mailing Address - Fax:727-545-0289
Practice Address - Street 1:8455 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1206
Practice Address - Country:US
Practice Address - Phone:727-545-2339
Practice Address - Fax:727-545-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0056017OtherMEDICAL LICENSE
FLP00087790OtherRAILROAD MEDICARE
FL031394700Medicaid
FL031394700Medicaid
FL14278Medicare PIN