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General NPI Number Information
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NPI Number | 1801112438
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Entity Type | Organization
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Legal Business Name | CHARLES D BISOGNO DO PA
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 201 HILDA ST SUITE 14
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City | KISSIMMEE
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State | FL
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Zip | 34741-2320
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Country | US
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Telephone | 407-846-8288
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Fax | 407-846-3162
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Provider Business Mailing Address
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Address Line | 201 HILDA ST SUITE 14
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City | KISSIMMEE
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State | FL
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Zip | 34741-2320
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Country | US
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Telephone | 407-846-8288
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Fax | 407-846-3162
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | CHARLES D BISOGNO
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Credential | D.O.
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Telephone | 407-846-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | OS4508
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS4508
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License Number State | FL
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