Provider Demographics
NPI:1316932536
Name:PESCITELLI, ALBERT RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:RICHARD
Last Name:PESCITELLI
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 1:7890 SUMMERLIN LAKES DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1851
Mailing Address - Country:US
Mailing Address - Phone:239-939-1999
Mailing Address - Fax:239-939-4935
Practice Address - Street 1:7890 SUMMERLIN LAKES DR
Practice Address - Street 2:SUITE #3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1851
Practice Address - Country:US
Practice Address - Phone:239-939-1999
Practice Address - Fax:239-939-4935
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2013-08-30
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FL0059299174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052728900Medicaid
FL008470600Medicaid
FLHB175AMedicare UPIN
FL052728900Medicaid
FL008470600Medicaid