Healthcare Provider Details

I. General information

NPI: 1134102973
Provider Name (Legal Business Name): THOMAS A DIGERONIMO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 W BAKER ST
PLANT CITY FL
33563-2851
US

IV. Provider business mailing address

3302 W BAKER ST
PLANT CITY FL
33563-2851
US

V. Phone/Fax

Practice location:
  • Phone: 813-752-1336
  • Fax: 813-754-6914
Mailing address:
  • Phone: 813-752-1336
  • Fax: 813-754-6914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME0054874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: