Provider Demographics
NPI:1902946627
Name:ESPOSITO, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:ESPOSITO
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 1:630 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2128
Mailing Address - Country:US
Mailing Address - Phone:727-360-1784
Mailing Address - Fax:727-360-1823
Practice Address - Street 1:630 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2128
Practice Address - Country:US
Practice Address - Phone:727-360-1784
Practice Address - Fax:727-360-1823
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013310900Medicaid
FL18111OtherBCBS
FLCIGNAOther6187573
FL6187573OtherCIGNA HEALTHCARE
FL18111WMedicare PIN
FL6187573OtherCIGNA HEALTHCARE
FL013310900Medicaid