Provider Demographics
NPI:1194979963
Name:VINCENT PIANELLI, MDPA
Entity type:Organization
Organization Name:VINCENT PIANELLI, MDPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-776-1180
Mailing Address - Street 1:PO BOX 23158
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-3158
Mailing Address - Country:US
Mailing Address - Phone:954-522-8561
Mailing Address - Fax:954-522-6602
Practice Address - Street 1:935 INTRACOASTAL DRIVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304
Practice Address - Country:US
Practice Address - Phone:954-522-8561
Practice Address - Fax:954-522-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048950600Medicaid
FL06830OtherMEDICARE ID
FLD67109Medicare UPIN