Provider Demographics
NPI:1124091533
Name:MARCANTONIO, ROBERT G (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:MARCANTONIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CATTLEMEN RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6056
Mailing Address - Country:US
Mailing Address - Phone:941-379-5121
Mailing Address - Fax:941-379-4239
Practice Address - Street 1:3333 CATTLEMEN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6056
Practice Address - Country:US
Practice Address - Phone:941-379-5121
Practice Address - Fax:941-379-4239
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02458WMedicare PIN
A68293Medicare UPIN