Provider Demographics
NPI:1568485852
Name:PECORARO, ALPHONSE M (MD)
Entity type:Individual
Prefix:DR
First Name:ALPHONSE
Middle Name:M
Last Name:PECORARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:490 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2871
Mailing Address - Country:US
Mailing Address - Phone:321-268-6868
Mailing Address - Fax:321-268-6265
Practice Address - Street 1:490 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2871
Practice Address - Country:US
Practice Address - Phone:321-268-6868
Practice Address - Fax:321-268-6235
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME85276208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264438000Medicaid
FL264438000Medicaid
FL13984ZMedicare PIN