Healthcare Provider Details

I. General information

NPI: 1093706145
Provider Name (Legal Business Name): ANGELA M MAIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ASHLEY DRIVE SUITE 1500
TAMPA FL
33602-5318
US

IV. Provider business mailing address

100 SOUTH ASHLEY DRIVE SUITE 1500
TAMPA FL
33602-5318
US

V. Phone/Fax

Practice location:
  • Phone: 813-899-6220
  • Fax: 813-985-8006
Mailing address:
  • Phone: 813-899-6220
  • Fax: 813-985-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME115816
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number191648
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME115816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: