Provider Demographics
NPI:1215921275
Name:PAPPAS, REGINE M (MD)
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:M
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 W EAU GALLIE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-255-4949
Mailing Address - Fax:321-255-0887
Practice Address - Street 1:1649 W EAU GALLIE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-255-4949
Practice Address - Fax:321-255-0887
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73882207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41999WOtherBC BS
FL252626300Medicaid
E65508Medicare UPIN
FL41999WOtherBC BS
FL5843980001Medicare NSC