Provider Demographics
NPI:1366423840
Name:AMATO, RICHARD ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:AMATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2730 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761
Mailing Address - Country:US
Mailing Address - Phone:727-286-8929
Mailing Address - Fax:727-286-8933
Practice Address - Street 1:8401 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6725
Practice Address - Country:US
Practice Address - Phone:330-729-2729
Practice Address - Fax:330-572-3836
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0674302085R0202X
FLME645122085R0202X
FLME150122085N0904X, 207UN0902X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0330570Medicaid
FLAC103OtherMEDICARE PTAN INNOVATIVE GROUP
FL23128ZOtherMEDICARE PTAN INNOVATIVE INDIVIDUAL
FL23128OtherBCBS
FL258751300Medicaid
FL23128ZOtherMEDICARE PTAN INNOVATIVE INDIVIDUAL