MEDICARE: DR. WAYNE PETER DIGIACOMO MD

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	207V00000X	Obstetrics & Gynecology Physician	ME0034571	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME0034571	OTHER	FL	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346205812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE PETER DIGIACOMO MD

Provider Business Mailing Address
First Line	:	3001 W HALLANDALE BEACH BLVD
Second Line	:	SUITE 200
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5155
Country	:	US
Telephone Number	:	954-456-4888
Fax Number	:	954-456-9721

Provider Business Practice Location Address
First Line	:	3001 W HALLANDALE BEACH BLVD
Second Line	:	SUITE 200
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5155
Country	:	US
Telephone Number	:	954-456-4888
Fax Number	:	954-456-9721

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	09/15/2008

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