Provider Demographics
NPI:1801112438
Name:CHARLES D BISOGNO DO PA
Entity type:Organization
Organization Name:CHARLES D BISOGNO DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BISOGNO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-846-8288
Mailing Address - Street 1:201 HILDA ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2320
Mailing Address - Country:US
Mailing Address - Phone:407-846-8288
Mailing Address - Fax:407-846-3162
Practice Address - Street 1:201 HILDA ST
Practice Address - Street 2:SUITE 14
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2320
Practice Address - Country:US
Practice Address - Phone:407-846-8288
Practice Address - Fax:407-846-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4508207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27372Medicare UPIN
FL82546Medicare PIN