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General NPI Number Information
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NPI Number | 1255664769
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Entity Type | Individual
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Provider Name | MARK LAWRENCE D'AGOSTINO M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1343 MAIN ST
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City | SARASOTA
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State | FL
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Zip | 34236-5637
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Country | US
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Telephone | 203-441-7374
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Fax |
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Provider Business Mailing Address
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Address Line | 5323 SIESTA COVE DR
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City | SARASOTA
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State | FL
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Zip | 34242-1702
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Country | US
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Telephone | 617-785-0404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 60333
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 270357
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2021-03385
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME144849
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License Number State | FL
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