MEDICARE: MR. DAVID FITZGERALD MARCONI M.D.

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	208M00000X	Hospitalist Physician	ME134109	FL
2	207Q00000X	Family Medicine Physician	ME134109	FL

General Provider Information

NPI Number	:	1225370984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID FITZGERALD MARCONI M.D.

Provider Business Mailing Address
First Line	:	6160 WINKLER RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8179
Country	:	US
Telephone Number	:	239-362-3005
Fax Number	:	239-362-3392

Provider Business Practice Location Address
First Line	:	6160 WINKLER RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8179
Country	:	US
Telephone Number	:	239-362-3005
Fax Number	:	239-362-3392

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

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	03/18/2022

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