Provider Demographics
NPI:1679534127
Name:MAGARDINO, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:MAGARDINO
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 1:1879 VETERANS PARK DR
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0492
Mailing Address - Country:US
Mailing Address - Phone:239-592-9666
Mailing Address - Fax:239-592-1835
Practice Address - Street 1:1879 VETERANS PARK DR
Practice Address - Street 2:SUITE 1201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0492
Practice Address - Country:US
Practice Address - Phone:239-592-9666
Practice Address - Fax:239-592-1835
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256207300Medicaid
FLG95236Medicare UPIN
FL256207300Medicaid