Provider Demographics
NPI:1154371169
Name:DIPASQUALE, BRUNO (MD)
Entity type:Individual
Prefix:
First Name:BRUNO
Middle Name:
Last Name:DIPASQUALE
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 1:2430 VANDERBILT BEACH ROAD
Mailing Address - Street 2:STE 108 PMB 323
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2430 VANDERBILT BEACH RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2654
Practice Address - Country:US
Practice Address - Phone:239-300-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81670207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260539200Medicaid
FLG83579Medicare UPIN