Provider Demographics
NPI:1427161181
Name:ADVANCED ALLERGY & ASTHMA CARE PA
Entity type:Organization
Organization Name:ADVANCED ALLERGY & ASTHMA CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LATHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAMARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-544-8100
Mailing Address - Street 1:6233 66TH ST NORTH
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5025
Mailing Address - Country:US
Mailing Address - Phone:727-544-8100
Mailing Address - Fax:727-544-8200
Practice Address - Street 1:6233 66TH ST NORTH
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-544-8100
Practice Address - Fax:727-544-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207K00000X, 207KA0200X, 2080P0201X
FLME65838207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256994901Medicaid
FL256994900Medicaid
FL25263BMedicare ID - Type Unspecified
FL256994901Medicaid