Provider Demographics
NPI:1275717605
Name:UROLOGY CENTRAL PA
Entity Type:Organization
Organization Name:UROLOGY CENTRAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GHADA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-298-6950
Mailing Address - Street 1:10000 W COLONIAL DR
Mailing Address - Street 2:STE 285
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3498
Mailing Address - Country:US
Mailing Address - Phone:407-298-6950
Mailing Address - Fax:407-578-2354
Practice Address - Street 1:1135 LAKE AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3037
Practice Address - Country:US
Practice Address - Phone:407-298-6950
Practice Address - Fax:407-578-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty