Provider Demographics
NPI:1215999446
Name:BAY REGIONAL & INTL INST. OF NEUROLOGY, INC
Entity type:Organization
Organization Name:BAY REGIONAL & INTL INST. OF NEUROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHAKRISHNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-876-3783
Mailing Address - Street 1:2508 W. SAINT ISABEL STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6380
Mailing Address - Country:US
Mailing Address - Phone:813-876-3783
Mailing Address - Fax:813-876-2525
Practice Address - Street 1:2508 W. SAINT ISABEL STREET
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6380
Practice Address - Country:US
Practice Address - Phone:813-876-3783
Practice Address - Fax:813-876-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375370100Medicaid
FL375370100Medicaid
FLK2211Medicare PIN
F87011Medicare UPIN