Provider Demographics
NPI:1215928882
Name:RADVANY, MARTIN GEZA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GEZA
Last Name:RADVANY
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 1:2115 CRYSTAL GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6875
Mailing Address - Country:US
Mailing Address - Phone:863-688-2334
Mailing Address - Fax:
Practice Address - Street 1:1305 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4542
Practice Address - Country:US
Practice Address - Phone:863-688-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1221782085N0700X, 2085R0204X, 2085N0700X
SC275532085R0204X
TXL11732085R0204X
PAMD4535892085R0204X
MDD481912085R0204X
ARE-110492085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN8828OtherFLORIDA MEDICARE
PAPO1739390OtherRAILROAD
PA102991632Medicaid
FL10434991OtherCAQH
FL111544500Medicaid
MD680451900Medicaid
MD680451901Medicaid
FLEFZ2ZOtherFLORIDA BCBS
FLQ00222997OtherRAILROAD MEDICARE