Provider Demographics
NPI:1336199710
Name:MAGGIO, DOMINIC C (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:C
Last Name:MAGGIO
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 1:1321 NW 14TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1673
Mailing Address - Country:US
Mailing Address - Phone:305-324-0220
Mailing Address - Fax:305-545-0790
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:305-324-0220
Practice Address - Fax:305-545-0790
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032856173000000X
FLME32856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200559432OtherTIN
FLD78982Medicare UPIN
FL96351ZMedicare ID - Type UnspecifiedMEDICARE