Provider Demographics
NPI:1447218250
Name:LANDMARK PRIMARY CARE PA
Entity Type:Organization
Organization Name:LANDMARK PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:/PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DUANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-354-9485
Mailing Address - Street 1:2221 N HIMES AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-3139
Mailing Address - Country:US
Mailing Address - Phone:813-354-9485
Mailing Address - Fax:813-354-9564
Practice Address - Street 1:2221 N HIMES AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3139
Practice Address - Country:US
Practice Address - Phone:813-354-9485
Practice Address - Fax:813-354-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024110800Medicaid
FLD55088Medicare UPIN