Basic Information
| Provider Information | |||||||||
| NPI: | 1114009651 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINELLAS HEMATOLOGY AND ONCOLOGY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 PARK ST N | ||||||||
| Address2: | SUITE 1017 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446569 | ||||||||
| FaxNumber: | 7273844388 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 PARK ST N | ||||||||
| Address2: | SUITE 1017 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446569 | ||||||||
| FaxNumber: | 7273844388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | DESAI | ||||||||
| AuthorizedOfficialFirstName: | PRATIBHA | ||||||||
| AuthorizedOfficialMiddleName: | KIRIT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7273446569 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | ME0093983 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | ME0066436 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.