Provider Demographics
NPI:1447499082
Name:LOPREATO, PAUL DOMINIC (PA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DOMINIC
Last Name:LOPREATO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3699 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41076-5121
Mailing Address - Country:US
Mailing Address - Phone:859-442-8444
Mailing Address - Fax:859-442-8777
Practice Address - Street 1:1051 PORT MALABAR BLVD NE STE 6-7
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5153
Practice Address - Country:US
Practice Address - Phone:800-735-1178
Practice Address - Fax:772-223-6354
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109473363A00000X
OHOH001095363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110227900Medicaid
FLPA9109473OtherFLORIDA MEDICAL BOARD