Provider Demographics
NPI:1245780394
Name:SUNCOAST MEDICAL ASSOCIATES CHARLOTTE PA
Entity Type:Organization
Organization Name:SUNCOAST MEDICAL ASSOCIATES CHARLOTTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEYKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-894-8297
Mailing Address - Street 1:2484 CARING WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5306
Mailing Address - Country:US
Mailing Address - Phone:941-208-2519
Mailing Address - Fax:941-451-2096
Practice Address - Street 1:2484 CARING WAY
Practice Address - Street 2:SUITE B
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5306
Practice Address - Country:US
Practice Address - Phone:941-208-2519
Practice Address - Fax:941-451-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty