Individual
PAUL ANTHONY MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2501 N ORANGE AVE STE 240, ORLANDO, FL 32804-4641
(407) 303-2615
Mailing address
2501 N ORANGE AVE STE 240, ORLANDO, FL 32804-4641
(407) 303-2615
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
ME90970
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271059500
—
FL
Enumeration date
04/11/2006
Last updated
11/23/2014
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