Basic Information
| Provider Information | |||||||||
| NPI: | 1063151405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAMPA GENERAL PROVIDER NETWORK INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000-7370 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552353496 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4949 4TH ST N | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337033800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136606950 | ||||||||
| FaxNumber: | 8136606622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2022 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARZBERG | ||||||||
| AuthorizedOfficialFirstName: | ABRAHAM | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5612533980 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TAMPA GENERAL PROVIDER NETWORK INC | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.