Provider Demographics
NPI:1093961799
Name:PEDIATRIC PULMONARY SPECIALISTS PA
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-870-1995
Mailing Address - Street 1:PO BOX 151637
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-1637
Mailing Address - Country:US
Mailing Address - Phone:813-870-1995
Mailing Address - Fax:813-875-1889
Practice Address - Street 1:2625 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3860
Practice Address - Country:US
Practice Address - Phone:813-870-1995
Practice Address - Fax:813-875-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274523200Medicaid