Provider Demographics
NPI:1265573414
Name:PETER RUGGIERO MD PA
Entity type:Organization
Organization Name:PETER RUGGIERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-644-1111
Mailing Address - Street 1:1200 W SR 434 STE 112
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4957
Mailing Address - Country:US
Mailing Address - Phone:407-869-8747
Mailing Address - Fax:407-869-8108
Practice Address - Street 1:1200 W SR 434 STE 112
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4957
Practice Address - Country:US
Practice Address - Phone:407-869-8747
Practice Address - Fax:407-869-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073282207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F23122Medicare UPIN
AB249Medicare PIN