Provider Demographics
NPI:1467499731
Name:TOD FUSIA & MARK SWIERZ
Entity Type:Organization
Organization Name:TOD FUSIA & MARK SWIERZ
Other - Org Name:TAMPA BAY UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TOD
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-875-5855
Mailing Address - Street 1:3837 NORTHDALE BLVD
Mailing Address - Street 2:PMB 176
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1841
Mailing Address - Country:US
Mailing Address - Phone:813-875-5855
Mailing Address - Fax:813-871-6139
Practice Address - Street 1:2822 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6330
Practice Address - Country:US
Practice Address - Phone:813-875-5855
Practice Address - Fax:813-871-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH6089OtherMEDICARE RAILROAD
FL=========OtherTAX IDENTIFICATION
FLK2067Medicare PIN