Provider Demographics
NPI:1013335488
Name:RAJO ANDRADE, MARCO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:RAJO ANDRADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6919 N DALE MABRY HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3972
Mailing Address - Country:US
Mailing Address - Phone:813-933-3324
Mailing Address - Fax:813-932-4357
Practice Address - Street 1:6919 N DALE MABRY HWY STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-933-3324
Practice Address - Fax:813-932-4357
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144166208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery