MEDICARE: DR. PETER ANTHONY VASALLO III 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	208D00000X	General Practice Physician	ME180364	FL

General Provider Information

NPI Number	:	1740982487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ANTHONY VASALLO III MD

Provider Business Mailing Address
First Line	:	321 MONTGOMERY RD UNIT 161805
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 MONTGOMERY RD UNIT 161805
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3121
Country	:	US
Telephone Number	:	321-279-0313
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	04/13/2026

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