Provider Demographics
NPI:1164744173
Name:THEODORE J. MACHLER, JR., M.D., P.A.
Entity Type:Organization
Organization Name:THEODORE J. MACHLER, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-381-5775
Mailing Address - Street 1:6740 CROSSWINDS DR N STE B
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5472
Mailing Address - Country:US
Mailing Address - Phone:727-381-5775
Mailing Address - Fax:727-381-9895
Practice Address - Street 1:6740 CROSSWINDS DR N STE B
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5472
Practice Address - Country:US
Practice Address - Phone:727-381-5775
Practice Address - Fax:727-381-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME000123702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT373AMedicare PIN