Basic Information
| Provider Information | |||||||||
| NPI: | 1508199969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | I V S NATH MD FRCP PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25233 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336225233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278232188 | ||||||||
| FaxNumber: | 7278280723 | ||||||||
| Practice Location | |||||||||
| Address1: | 6217 66TH ST | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337815025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275461680 | ||||||||
| FaxNumber: | 7275469746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2009 | ||||||||
| LastUpdateDate: | 12/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | NATH | ||||||||
| AuthorizedOfficialFirstName: | IYYUNI | ||||||||
| AuthorizedOfficialMiddleName: | V S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7275461680 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME47362 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 065241500 | 05 | FL | MEDICAID |