Basic Information
| Provider Information | |||||||||
| NPI: | 1639317639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORCELLA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11528 US HWY 19 | ||||||||
| Address2: | |||||||||
| City: | PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278682151 | ||||||||
| FaxNumber: | 7278688251 | ||||||||
| Practice Location | |||||||||
| Address1: | 9238 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346684853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278498492 | ||||||||
| FaxNumber: | 7278493472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207RI0011X | OS10547 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | OS10547 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 002448600 | 05 | FL | MEDICAID | 21776502 | 01 | FL | WELLMED | OTHER | 21776501 | 01 | FL | WELLMED | OTHER | 332801 | 01 | FL | AVMED | OTHER | 14A51 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 2196537 | 01 | FL | COVENTRY | OTHER |