MEDICARE: GIA P AGRESTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME87548	FL

General Provider Information

NPI Number	:	1457354375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIA P AGRESTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 861295
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-1295
Country	:	US
Telephone Number	:	813-636-2040
Fax Number	:	813-636-2020

Provider Business Practice Location Address
First Line	:	1202 S CHURCH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5036
Country	:	US
Telephone Number	:	813-254-8055
Fax Number	:	813-254-7240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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