Provider Demographics
NPI:1447355748
Name:WILLIAM C GAMBERINO, MD, PHD, LLC
Entity type:Organization
Organization Name:WILLIAM C GAMBERINO, MD, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GAMBERINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:352-291-1717
Mailing Address - Street 1:3002 SE 1ST AVE
Mailing Address - Street 2:BLDG 100
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0477
Mailing Address - Country:US
Mailing Address - Phone:352-291-1717
Mailing Address - Fax:352-368-7796
Practice Address - Street 1:3002 SE 1ST AVE
Practice Address - Street 2:BLDG 100
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0477
Practice Address - Country:US
Practice Address - Phone:352-291-1717
Practice Address - Fax:352-368-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 745992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35476Medicare ID - Type Unspecified
H27004Medicare UPIN