Provider Demographics
NPI:1487970679
Name:ANAL RECTAL CLINIC PA
Entity type:Organization
Organization Name:ANAL RECTAL CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CESARE
Authorized Official - Middle Name:PAOLO
Authorized Official - Last Name:PERAGLIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-922-3424
Mailing Address - Street 1:1354 CELEBRATION AVENUE
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747
Mailing Address - Country:US
Mailing Address - Phone:407-922-3424
Mailing Address - Fax:
Practice Address - Street 1:40124 HIGHWAY 27 STE 203
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5905
Practice Address - Country:US
Practice Address - Phone:407-922-3424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92642208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty