Provider Demographics
NPI:1275671745
Name:BAY AREA MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:BAY AREA MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SAFDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-715-4446
Mailing Address - Street 1:PO BOX 48589
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-0122
Mailing Address - Country:US
Mailing Address - Phone:813-715-4446
Mailing Address - Fax:813-780-7786
Practice Address - Street 1:37900 DAUGHTERY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1316
Practice Address - Country:US
Practice Address - Phone:813-715-4446
Practice Address - Fax:813-780-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070811207R00000X
FLME0041877207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK2071OtherRAILROAD MEDICARE
K3390Medicare ID - Type Unspecified