MEDICARE: ERASMO A. PASSARO 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	2084N0600X	Clinical Neurophysiology Physician	ME67462	FL
2	2084D0003X	Diagnostic Neuroimaging (Psychiatry & Neurology) Physician	ME67462	FL
3	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	ME67462	FL
4	2084N0400X	Neurology Physician	ME67462	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972599439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERASMO A. PASSARO M.D.

Provider Business Mailing Address
First Line	:	1607 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-4226
Country	:	US
Telephone Number	:	727-329-8833
Fax Number	:	727-329-8840

Provider Business Practice Location Address
First Line	:	1607 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-4226
Country	:	US
Telephone Number	:	727-329-8833
Fax Number	:	727-329-8840

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	06/27/2014

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