1598810343 NPI number — DR. ANTHONY J PACITTI M.D.

Table of content: DR. ANTHONY J PACITTI M.D. (NPI 1598810343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598810343 NPI number — DR. ANTHONY J PACITTI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACITTI
Provider First Name:
ANTHONY
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
PACITTI, MD, PA
Provider Other First Name:
ANTHONY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598810343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32885-0192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-282-6331
Provider Business Mailing Address Fax Number:
904-282-1550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 ZEAGLER DR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PALATKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32177-3888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-312-8519
Provider Business Practice Location Address Fax Number:
386-312-8523
Provider Enumeration Date:
01/24/2007

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: 208600000X , with the licence number:  ME78644 , 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: 47079 . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 256869100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020046738 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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