Provider Demographics
NPI:1114009651
Name:PINELLAS HEMATOLOGY AND ONCOLOGY PA
Entity Type:Organization
Organization Name:PINELLAS HEMATOLOGY AND ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:KIRIT
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-344-6569
Mailing Address - Street 1:5000 PARK ST N
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2221
Mailing Address - Country:US
Mailing Address - Phone:727-344-6569
Mailing Address - Fax:727-384-4388
Practice Address - Street 1:5000 PARK ST N
Practice Address - Street 2:SUITE 1017
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2221
Practice Address - Country:US
Practice Address - Phone:727-344-6569
Practice Address - Fax:727-384-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066436207RH0003X
FLME0093983207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4615780001Medicare NSC