Provider Demographics
NPI:1972605434
Name:MONGE, FABRIZIO (MD)
Entity Type:Individual
Prefix:DR
First Name:FABRIZIO
Middle Name:
Last Name:MONGE
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 1:4235 KINGS HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8421
Mailing Address - Country:US
Mailing Address - Phone:941-613-1777
Mailing Address - Fax:941-613-1779
Practice Address - Street 1:25086 OLYMPIA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3933
Practice Address - Country:US
Practice Address - Phone:941-205-5300
Practice Address - Fax:941-205-5302
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100488207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35131OtherBCBS
FL000330600Medicaid
AK91SYMedicare PIN