Provider Demographics
NPI:1174859052
Name:MEDICAL GROUP OF PINELLAS, PA
Entity Type:Organization
Organization Name:MEDICAL GROUP OF PINELLAS, PA
Other - Org Name:NORTHEAST PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BHUMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-526-7337
Mailing Address - Street 1:431 SOUTHWEST BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-6822
Mailing Address - Country:US
Mailing Address - Phone:727-526-7337
Mailing Address - Fax:727-528-7337
Practice Address - Street 1:431 SOUTHWEST BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1399
Practice Address - Country:US
Practice Address - Phone:727-526-7337
Practice Address - Fax:727-528-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty