Provider Demographics
NPI:1063770469
Name:RATHI, SIDDARTH (MD, MBA)
Entity type:Individual
Prefix:
First Name:SIDDARTH
Middle Name:
Last Name:RATHI
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 13TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3127
Mailing Address - Country:US
Mailing Address - Phone:727-581-8706
Mailing Address - Fax:727-588-2447
Practice Address - Street 1:148 13TH ST SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770
Practice Address - Country:US
Practice Address - Phone:727-581-8706
Practice Address - Fax:727-588-2447
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126967207WX0009X, 207W00000X
NY277734207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist