Provider Demographics
NPI:1952350811
Name:CACCIATORE, HENRY ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ANTHONY
Last Name:CACCIATORE
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 1:2822 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6330
Mailing Address - Country:US
Mailing Address - Phone:813-875-5855
Mailing Address - Fax:813-871-6139
Practice Address - Street 1:2822 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6330
Practice Address - Country:US
Practice Address - Phone:813-875-5855
Practice Address - Fax:813-871-6139
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME9675208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL432440000Medicaid
FL29584ZMedicare ID - Type UnspecifiedMEDICARE ID
FLD53630Medicare UPIN