Provider Demographics
NPI:1588646558
Name:DE GIROLAMI, RICCARDO M (M D)
Entity type:Individual
Prefix:DR
First Name:RICCARDO
Middle Name:M
Last Name:DE GIROLAMI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 HIGHWAY 44 W
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3805
Mailing Address - Country:US
Mailing Address - Phone:352-637-6100
Mailing Address - Fax:352-637-6900
Practice Address - Street 1:2105 HIGHWAY 44 W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3805
Practice Address - Country:US
Practice Address - Phone:352-637-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME402672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371982100Medicaid
FL08800OtherBCBS
FL371982100Medicaid
FL08800ZMedicare PIN
FL08800OtherBCBS
FLE22622Medicare UPIN
FL300037649 RR MCRMedicare PIN