Healthcare Provider Details

I. General information

NPI: 1689652729
Provider Name (Legal Business Name): JAMES W. BATTAGLINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S APOLLO BLVD SUITE B
MELBOURNE FL
32901-4484
US

IV. Provider business mailing address

PO BOX 561600
ROCKLEDGE FL
32956-1600
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-3455
  • Fax: 321-434-3456
Mailing address:
  • Phone: 321-434-4600
  • Fax: 321-259-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0048728
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME48728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: