Basic Information
| Provider Information | |||||||||
| NPI: | 1750594628 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATHINASAMY | ||||||||
| FirstName: | DILIP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 S BUNGALOW PARK AVE | ||||||||
| Address2: | UNIT B | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336093159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138782020 | ||||||||
| FaxNumber: | 8132492020 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 VONDERBURG DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136811122 | ||||||||
| FaxNumber: | 8136844924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME98257 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 000121500 | 05 | FL | MEDICAID |