Healthcare Provider Details

I. General information

NPI: 1053636829
Provider Name (Legal Business Name): MARKUS ANGELO DORIA AGITO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 S CHICKASAW TRL STE 301
ORLANDO FL
32825-3501
US

IV. Provider business mailing address

258 S CHICKASAW TRL STE 301
ORLANDO FL
32825-3501
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-3674
  • Fax: 407-821-3675
Mailing address:
  • Phone: 407-821-3674
  • Fax: 407-821-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-120882
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME132755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: