Healthcare Provider Details

I. General information

NPI: 1124276167
Provider Name (Legal Business Name): CENTER FOR HEALTH OF CHARLOTTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 W MARION AVE 116
PUNTA GORDA FL
33950-5372
US

IV. Provider business mailing address

1107 W MARION AVE 116
PUNTA GORDA FL
33950-5372
US

V. Phone/Fax

Practice location:
  • Phone: 941-637-7000
  • Fax: 941-639-7576
Mailing address:
  • Phone: 941-637-7000
  • Fax: 941-639-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0055973
License Number StateFL

VIII. Authorized Official

Name: DAVID E RUGGIERI
Title or Position: CEO
Credential: M.D.
Phone: 941-637-7000