MEDICARE: GUILLERMO W COSMA 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	2084P0800X	Psychiatry Physician	00118063	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962498386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUILLERMO W COSMA M.D.

Provider Business Mailing Address
First Line	:	1305 S FORT HARRISON AVE
Second Line	:	BLDG F
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3301
Country	:	US
Telephone Number	:	727-441-3857
Fax Number	:	727-449-2508

Provider Business Practice Location Address
First Line	:	1305 S FORT HARRISON AVE
Second Line	:	BLDG F
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3301
Country	:	US
Telephone Number	:	727-441-3857
Fax Number	:	727-449-2508

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	03/16/2011

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