Provider Demographics
NPI:1346309010
Name:STEVEN D GITOMER MD PA
Entity Type:Organization
Organization Name:STEVEN D GITOMER MD PA
Other - Org Name:STEVEN D GITOMER MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GITOMER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:813-969-2340
Mailing Address - Street 1:6516 GUNN HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-4022
Mailing Address - Country:US
Mailing Address - Phone:813-969-2340
Mailing Address - Fax:813-969-3877
Practice Address - Street 1:6516 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4022
Practice Address - Country:US
Practice Address - Phone:813-969-2340
Practice Address - Fax:813-969-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
=========OtherTAX ID
FLD54022Medicare UPIN