Provider Demographics
NPI:1437390390
Name:IVANCSITS, DOUGLAS PETER (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:PETER
Last Name:IVANCSITS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 UNIVERSITY SQUARE DR
Mailing Address - Street 2:RADIOLOGY ASSOC OF TAMPA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:813-254-4597
Practice Address - Street 1:2700 UNIVERSITY SQUARE DR
Practice Address - Street 2:RADIOLOGY ASSOC OF TAMPA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5513
Practice Address - Country:US
Practice Address - Phone:813-251-5822
Practice Address - Fax:813-254-4597
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1103792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012100700Medicaid
FLID925ZMedicare PIN
FL012100700Medicaid
FLID925XMedicare PIN