Healthcare Provider Details

I. General information

NPI: 1609079797
Provider Name (Legal Business Name): ROBERT M CRESCENTINI II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6307
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 813-321-6589
  • Fax: 813-321-6590
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME107896
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME107896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: