Provider Demographics
NPI:1972599439
Name:PASSARO, ERASMO A (MD)
Entity Type:Individual
Prefix:
First Name:ERASMO
Middle Name:A
Last Name:PASSARO
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 1:1607 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4226
Mailing Address - Country:US
Mailing Address - Phone:727-329-8833
Mailing Address - Fax:727-329-8840
Practice Address - Street 1:1607 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4226
Practice Address - Country:US
Practice Address - Phone:727-329-8833
Practice Address - Fax:727-329-8840
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME674622084N0600X, 2084D0003X, 2084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377801100Medicaid
FL26850YMedicare ID - Type Unspecified
FLF59587Medicare UPIN