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General NPI Number Information
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NPI Number | 1518204619
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Entity Type | Organization
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Legal Business Name | ANTHONY D'AGOSTINO MD PA
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 1350 9TH ST N SUITE 201
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City | NAPLES
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State | FL
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Zip | 34102-5209
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Country | US
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Telephone | 239-262-6111
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Fax | 239-435-3920
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Provider Business Mailing Address
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Address Line | 1350 9TH ST N SUITE 201
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City | NAPLES
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State | FL
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Zip | 34102-5209
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Country | US
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Telephone | 239-262-6111
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Fax | 239-435-3920
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Authorized Official
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Title or Position | PA
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Name | ANTHONY D'AGOSTINO
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Credential | MD
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Telephone | 239-262-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 10D0944089
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME0066399
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License Number State | FL
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