Healthcare Provider Details

I. General information

NPI: 1861464794
Provider Name (Legal Business Name): RICHARD EDWARD LOSARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 SW FEDERAL HWY SUITE 213
STUART FL
34994-2962
US

IV. Provider business mailing address

2740 SW MARTIN DOWNS BLVD #305
PALM CITY FL
34990-6046
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-8826
  • Fax: 772-283-5531
Mailing address:
  • Phone: 772-286-8826
  • Fax: 772-283-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME61588
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME61588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: