Provider Demographics
NPI:1053307488
Name:SUMESH CHANDRA MD PA
Entity Type:Organization
Organization Name:SUMESH CHANDRA MD PA
Other - Org Name:ENDOCRINE, OSTEOPOROSIS & THYROID CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-977-5557
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3937
Mailing Address - Country:US
Mailing Address - Phone:813-977-5557
Mailing Address - Fax:813-972-9211
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3937
Practice Address - Country:US
Practice Address - Phone:813-977-5557
Practice Address - Fax:813-972-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034899207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270620200Medicaid
FL74830OtherBCBS GROUP NUMBER
FLDB6684OtherRR MCARE GROUP