Provider Demographics
NPI:1992861785
Name:NEW LUNG ASSOCIATES PA
Entity type:Organization
Organization Name:NEW LUNG ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:8123-844-4634
Mailing Address - Street 1:16057 TAMPA PALMS BLVD W
Mailing Address - Street 2:BOX 409
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2001
Mailing Address - Country:US
Mailing Address - Phone:813-844-4634
Mailing Address - Fax:813-631-1737
Practice Address - Street 1:5 TAMPA GENERAL CIRCLE
Practice Address - Street 2:HARBORSIDE TOWERS, SUITE 450
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3589
Practice Address - Country:US
Practice Address - Phone:813-844-4634
Practice Address - Fax:813-631-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62408207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279353900Medicaid
FL279353900Medicaid