Provider Demographics
NPI:1235327008
Name:ADVANCED PRIMARY CARE AND GERIATRICS PA
Entity Type:Organization
Organization Name:ADVANCED PRIMARY CARE AND GERIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMANABABU
Authorized Official - Middle Name:V
Authorized Official - Last Name:PALADUGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-319-8900
Mailing Address - Street 1:PO BOX 3925
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-3925
Mailing Address - Country:US
Mailing Address - Phone:727-319-8900
Mailing Address - Fax:727-319-8700
Practice Address - Street 1:11200 SEMINOLE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33778-3239
Practice Address - Country:US
Practice Address - Phone:727-319-8900
Practice Address - Fax:727-319-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79071207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA4797OtherRAILROAD MEDICARE-GR
FL269169800Medicaid
FL06126OtherBLUESHIELD
FL293163OtherAVMED INDIVIDUAL
FL593016732OtherHUMANA
FL327963OtherAETNA
FLP00060383OtherRAILROAD MEDICARE -IND
FL269169800Medicaid
FLDA4797OtherRAILROAD MEDICARE-GR
FLG1933OtherAVMED-GROUP
FLE3686YOtherMEDICARE INDIVIDUAL PIN
FLP00060383OtherRAILROAD MEDICARE -IND
FLK4638Medicare PIN