Provider Demographics
NPI:1619267663
Name:PUSATERI, ALLEN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:JOSEPH
Last Name:PUSATERI
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 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:13602 N 46TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4931
Practice Address - Country:US
Practice Address - Phone:813-972-4444
Practice Address - Fax:813-979-1600
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119965207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIR502Y-TPAMedicare PIN
FLP01720479-RAILROADMedicare PIN
FLIR502Z-PASCOMedicare PIN