Basic Information
| Provider Information | |||||||||
| NPI: | 1366423840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMATO | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2730 N MCMULLEN BOOTH RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272868929 | ||||||||
| FaxNumber: | 7272868933 | ||||||||
| Practice Location | |||||||||
| Address1: | 8401 MARKET ST | ||||||||
| Address2: | |||||||||
| City: | BOARDMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445126725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307292729 | ||||||||
| FaxNumber: | 3305723836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35.067430 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME64512 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0330570 | 05 | OH | MEDICAID | AC103 | 01 | FL | MEDICARE PTAN INNOVATIVE GROUP | OTHER | 23128Z | 01 | FL | MEDICARE PTAN INNOVATIVE INDIVIDUAL | OTHER | 23128 | 01 | FL | BCBS | OTHER | 258751300 | 05 | FL | MEDICAID |