MEDICARE: ROBERT RICHARD PINELLO PAC MPAS

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	004478	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004478	OTHER	GA	GA MEDICAL BOARD PA LICEN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215955760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RICHARD PINELLO PAC MPAS

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-424-1400
Fax Number	:	239-424-1421

Provider Business Practice Location Address
First Line	:	3501 HEALTH CENTER BLVD
Second Line	:	SUITE 2310
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-8130
Country	:	US
Telephone Number	:	239-992-0558
Fax Number	:	239-992-2663

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/29/2021

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