Provider Demographics
NPI:1255849055
Name:BAY AREA NEUROLOGY LLC
Entity Type:Organization
Organization Name:BAY AREA NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-441-6803
Mailing Address - Street 1:3225 S MACDILL AVE STE 129-300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8171
Mailing Address - Country:US
Mailing Address - Phone:813-441-6803
Mailing Address - Fax:813-524-6352
Practice Address - Street 1:3225 S MACDILL AVE STE 129-300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8171
Practice Address - Country:US
Practice Address - Phone:813-441-6803
Practice Address - Fax:813-524-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011056550Medicaid