MEDICARE: ANTHONY A. AZZARELLO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9103151	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073568747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY A. AZZARELLO PA

Provider Business Mailing Address
First Line	:	PO BOX BOX 864074
Second Line	:	HALIFAX HEALTHCARE SYSTEMS, INC.
City	:	ORLANDO
State	:	FL
Zip	:	32886-4074
Country	:	US
Telephone Number	:	386-226-4590
Fax Number	:	386-226-3371

Provider Business Practice Location Address
First Line	:	303 NO. CLYDE MORRIS BLVD.
Second Line	:	HALIFAX MEDICAL CENTER - CHEST PAIN CENTER
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2709
Country	:	US
Telephone Number	:	386-425-1800
Fax Number	:	386-425-1804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	10/26/2011

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