Provider Demographics
NPI:1437244738
Name:NELSON M PICHARDO MD, LLC
Entity Type:Organization
Organization Name:NELSON M PICHARDO MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:PICHARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-421-9447
Mailing Address - Street 1:10051 5TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2211
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:813-514-8891
Practice Address - Street 1:2228 S KIRKMAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2308
Practice Address - Country:US
Practice Address - Phone:407-615-8180
Practice Address - Fax:407-615-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-70866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6073Medicare ID - Type UnspecifiedGROUP # FOR MEDICARE