MEDICARE: TAMPA BAY ENT & COSMETIC SURGERY PA

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician		FL

General Provider Information

NPI Number	:	1912092321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY ENT & COSMETIC SURGERY PA

Provider Business Mailing Address
First Line	:	5105 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1405
Country	:	US
Telephone Number	:	813-879-8045
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1405
Country	:	US
Telephone Number	:	813-879-8045
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ PHYSICIAN
Name	:	DR. DENNIS S AGLIANO
Credential	:	MD
Telephone Number	:	813-879-8045

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	03/22/2010

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