Provider Demographics
NPI:1134274673
Name:THOMAS A DIGERONIMO MD PA
Entity type:Organization
Organization Name:THOMAS A DIGERONIMO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIGERONIMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-752-1336
Mailing Address - Street 1:3302 W BAKER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2851
Mailing Address - Country:US
Mailing Address - Phone:813-752-1336
Mailing Address - Fax:813-754-6914
Practice Address - Street 1:3302 W BAKER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2851
Practice Address - Country:US
Practice Address - Phone:813-752-1336
Practice Address - Fax:813-754-6914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250908300Medicaid
FL40793Medicare ID - Type Unspecified