Provider Demographics
NPI:1093851594
Name:PALANISAMY RATHINASAMY MD PA
Entity Type:Organization
Organization Name:PALANISAMY RATHINASAMY MD PA
Other - Org Name:SURGICAL ASSOCIATES OF TAMPA BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KALYANAMATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHINASAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-681-4644
Mailing Address - Street 1:205 S.MOON AVE, SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5716
Mailing Address - Country:US
Mailing Address - Phone:813-681-4644
Mailing Address - Fax:813-654-4486
Practice Address - Street 1:205 S.MOON AVE, SUITE 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5716
Practice Address - Country:US
Practice Address - Phone:813-681-4644
Practice Address - Fax:813-654-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD0347OtherR.R.MEDICARE
FL265818600Medicaid
5410665OtherAETNA
72056Medicare PIN
CD0347OtherR.R.MEDICARE
FLD85581Medicare UPIN
FLG88318Medicare UPIN
5410665OtherAETNA
FLG29812Medicare UPIN