Provider Demographics
NPI:1285705004
Name:OHARA, MITCHELL B (DO)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:B
Last Name:OHARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MEDICAL PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4696
Mailing Address - Country:US
Mailing Address - Phone:813-497-9661
Mailing Address - Fax:813-615-8468
Practice Address - Street 1:3000 MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-497-9661
Practice Address - Fax:813-615-8468
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5698207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592998397COtherHUMANA
FL243268OtherAUMED
FL060033293OtherRAILROAD MEDICARE
FL378982900Medicaid
FL00658OtherUNIVERSAL
FL4661242OtherAETNA
G03277Medicare UPIN
FL060033293OtherRAILROAD MEDICARE