=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275665549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTONINO GIOVANNI ZAMPOGNA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1350 TAMIAMI TRAIL N #205
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-1910
-----------------------------------------------------
Fax | 239-263-5424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1350 TAMIAMI TRAIL N #205
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-1910
-----------------------------------------------------
Fax | 239-263-5424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTONINO G. ZAMPOGNA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 239-263-1910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME0034229
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------