Provider Demographics
NPI:1053636829
Name:AGITO, MARKUS ANGELO DORIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARKUS
Middle Name:ANGELO DORIA
Last Name:AGITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 S CHICKASAW TRL STE 301
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3501
Mailing Address - Country:US
Mailing Address - Phone:407-821-3674
Mailing Address - Fax:407-821-3675
Practice Address - Street 1:258 S CHICKASAW TRL STE 301
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3501
Practice Address - Country:US
Practice Address - Phone:407-821-3674
Practice Address - Fax:407-821-3675
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132755207RG0100X
OH35-120882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0454744OtherAKRON GENERAL MEDICAL CENTER/IMCA MEDICAID GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
FLJB432ZOtherMEDICARE
FL021533100Medicaid
OH1821035940OtherAKRON GENERAL MEDICAL CENTER/IMCA TYPE 2 NPI #
OH0083880Medicaid
OH3600271OtherAKRON GENERAL MEDICAL CENTER/ IMCA MEDICARE GROUP #
FL021533100Medicaid