1518045640 NPI number — NOEL PAGLOMUTAN RONGO M.D.

Table of content: NOEL PAGLOMUTAN RONGO M.D. (NPI 1518045640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518045640 NPI number — NOEL PAGLOMUTAN RONGO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RONGO
Provider First Name:
NOEL
Provider Middle Name:
PAGLOMUTAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518045640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5410 MARYLAND WAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-377-5667
Provider Business Mailing Address Fax Number:
888-241-1404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2776 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
SUITE 8228
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-5864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-334-5837
Provider Business Practice Location Address Fax Number:
239-334-5266
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME90184 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03545 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273338200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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