MEDICARE: GRACIELA O DEBOCCARDO MD

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	207RN0300X	Nephrology Physician	134410	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609892553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIELA O DEBOCCARDO MD

Provider Business Mailing Address
First Line	:	2852 TAMIAMI TRL STE 1
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5100
Country	:	US
Telephone Number	:	941-505-8720
Fax Number	:	941-505-8747

Provider Business Practice Location Address
First Line	:	2852 TAMIAMI TRL STE 1
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5100
Country	:	US
Telephone Number	:	941-505-8720
Fax Number	:	941-505-8747

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/24/2025

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