Provider Demographics
NPI:1235120494
Name:COLBASSANI, HAROLD J (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:J
Last Name:COLBASSANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:400 PINELLAS ST
Practice Address - Street 2:SUITE 325
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3312
Practice Address - Country:US
Practice Address - Phone:727-298-6121
Practice Address - Fax:727-533-5903
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58082207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01257159OtherMEDICARE RAILROAD PROVIDER NUMBER
FL001214300Medicaid
F17664Medicare UPIN
FL001214300Medicaid
FL14580WMedicare PIN