Basic Information
| Provider Information | |||||||||
| NPI: | 1881689487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIEUMONT | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 UNIVERSITY SQUARE DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336125513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132532721 | ||||||||
| FaxNumber: | 8132532299 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 TAMPA GENERAL CIRCLE | ||||||||
| Address2: | RADIOLOGY DEPARTMENT | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132532721 | ||||||||
| FaxNumber: | 8139773720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 75363 | MA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME74591 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 75363 | MA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | ME74591 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300095289 | 01 | MA | RAILROAD MEDICARE | OTHER | 2042658 | 01 | MA | FIRST HEALTH & CCN | OTHER | 3138402 | 05 | MA | MEDICAID | 01Y002005MA01 | 01 | NH | NH BLUE SHIELD | OTHER | 4059948 | 01 | MA | CIGNA | OTHER | 750289 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 2892557 | 01 | MA | AETNA/US HEALTHCARE | OTHER | J31215 | 01 | MA | BLUE CROSS/BLUE SHIELD | OTHER | 30203121 | 01 | NH | NH MEDICAID | OTHER | 25160 | 01 | MA | HEALTHY START | OTHER | 241009 | 01 | MA | HARVARD PILGRIM HEALTHCAR | OTHER | 3281 | 01 | MA | FALLON | OTHER | 998109 | 01 | MA | NETWORK | OTHER |