Provider Demographics
NPI:1881675643
Name:CIMINO, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:CIMINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8045 SPYGLASS HILL RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8567
Mailing Address - Country:US
Mailing Address - Phone:321-610-7105
Mailing Address - Fax:321-610-4975
Practice Address - Street 1:8045 SPYGLASS HILL RD
Practice Address - Street 2:STE 105
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8567
Practice Address - Country:US
Practice Address - Phone:321-610-7105
Practice Address - Fax:321-610-4975
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME580762080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL666859OtherAETNA
FL10823OtherBLUE CROSS BLUE SHIELD
FL063700900Medicaid
FL6121423006OtherCIGNA
FL18244OtherWELLCARE
FL4130489OtherAETNA
FL18244OtherWELLCARE
FL666859OtherAETNA