1336141241 NPI number — DR. DAVID F SCIORTINO MD

Table of content: DR. DAVID F SCIORTINO MD (NPI 1336141241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336141241 NPI number — DR. DAVID F SCIORTINO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCIORTINO
Provider First Name:
DAVID
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1336141241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10744
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33757-8744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-532-0002
Provider Business Mailing Address Fax Number:
727-266-4943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 W DR MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33607-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-321-6589
Provider Business Practice Location Address Fax Number:
813-321-6590
Provider Enumeration Date:
08/10/2005

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: 207RH0003X , with the licence number:  MD433462 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: ME112769 , 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: 03057605 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14P2Q . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1022460940001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014173100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4570963 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0737002 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".