Provider Demographics
NPI:1043200538
Name:ESROV, HARVEY N (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:N
Last Name:ESROV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 GREEN FOREST LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5388
Mailing Address - Country:US
Mailing Address - Phone:813-920-5200
Mailing Address - Fax:813-920-5228
Practice Address - Street 1:11375 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5409
Practice Address - Country:US
Practice Address - Phone:813-920-5200
Practice Address - Fax:813-920-5228
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00205052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180404I52Medicare ID - Type Unspecified
B94291Medicare UPIN