Provider Demographics
NPI:1891745576
Name:GAYOSO, MARCIA DELORME (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:DELORME
Last Name:GAYOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:815 WOODBURY RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4515
Mailing Address - Country:US
Mailing Address - Phone:407-208-9870
Mailing Address - Fax:407-208-9868
Practice Address - Street 1:815 WOODBURY RD
Practice Address - Street 2:SUITE #102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4515
Practice Address - Country:US
Practice Address - Phone:407-208-9870
Practice Address - Fax:407-208-9868
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0084749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000584800Medicaid