Basic Information
Provider Information
NPI: 1184603920
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOSHI
FirstName: KEDARNARTH
MiddleName: B
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 23057
Address2:  
City: TAMPA
State: FL
PostalCode: 336232057
CountryCode: US
TelephoneNumber: 8138996226
FaxNumber: 8139858006
Practice Location
Address1: 3100 E FLETCHER AVE
Address2:  
City: TAMPA
State: FL
PostalCode: 336134613
CountryCode: US
TelephoneNumber: 8138996226
FaxNumber: 8139858006
Other Information
ProviderEnumerationDate: 01/11/2006
LastUpdateDate: 11/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XME 30307FLY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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