Provider Demographics
NPI:1588779482
Name:GULF COAST ALLERGY CENTER PA
Entity type:Organization
Organization Name:GULF COAST ALLERGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:USHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAHASA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-743-2277
Mailing Address - Street 1:PO BOX 494507
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-4507
Mailing Address - Country:US
Mailing Address - Phone:941-743-2277
Mailing Address - Fax:941-743-2275
Practice Address - Street 1:3400 TAMIAMI TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8102
Practice Address - Country:US
Practice Address - Phone:941-743-2277
Practice Address - Fax:941-743-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84695207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17055OtherBCBS FL
FL17055OtherBCBS FL
H69109Medicare UPIN