Provider Demographics
NPI:1861464794
Name:LOSARDO, RICHARD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:LOSARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2740 SW MARTIN DOWNS BLVD
Mailing Address - Street 2:#305
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-6046
Mailing Address - Country:US
Mailing Address - Phone:772-286-8826
Mailing Address - Fax:772-283-5531
Practice Address - Street 1:789 SW FEDERAL HWY
Practice Address - Street 2:SUITE 213
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2962
Practice Address - Country:US
Practice Address - Phone:772-286-8826
Practice Address - Fax:772-283-5531
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-04
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME615882084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3297Medicare ID - Type Unspecified