Provider Demographics
NPI:1194113340
Name:TAMPA BAY DIABETES, THYROID, & ENDOCRINOLOGY CENTER, PA
Entity type:Organization
Organization Name:TAMPA BAY DIABETES, THYROID, & ENDOCRINOLOGY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARANASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-345-5222
Mailing Address - Street 1:5775 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7103
Mailing Address - Country:US
Mailing Address - Phone:727-345-5222
Mailing Address - Fax:727-345-4066
Practice Address - Street 1:5775 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7103
Practice Address - Country:US
Practice Address - Phone:727-345-5222
Practice Address - Fax:727-345-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108742174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty