MEDICARE: TONI MARIE MUZZONIGRO D.O.

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	207Q00000X	Family Medicine Physician	5101017454	MI
2	207Q00000X	Family Medicine Physician	OS016036	PA
3	207Q00000X	Family Medicine Physician	OS11766	FL

General Provider Information

NPI Number	:	1306042148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI MARIE MUZZONIGRO D.O.

Provider Business Mailing Address
First Line	:	3030 GARRETT RD
Second Line	:
City	:	DREXEL HILL
State	:	PA
Zip	:	19026-2217
Country	:	US
Telephone Number	:	610-622-7933
Fax Number	:	610-622-7937

Provider Business Practice Location Address
First Line	:	7575 DR PHILLIPS BLVD STE 370
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7220
Country	:	US
Telephone Number	:	407-377-7257
Fax Number	:	407-542-9836

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	03/26/2019

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