Provider Demographics
NPI:1871565051
Name:DEGREGORIO, RICHARD (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DEGREGORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:DEGREGORIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:8455 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-1206
Mailing Address - Country:US
Mailing Address - Phone:727-545-2339
Mailing Address - Fax:727-545-0289
Practice Address - Street 1:8455 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1206
Practice Address - Country:US
Practice Address - Phone:727-545-2339
Practice Address - Fax:727-545-0289
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56017207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031394700Medicaid
FL031394700Medicaid
FLBP176ZMedicare PIN