Provider Demographics
NPI:1467721985
Name:SUHAS JOSHI, MD PA
Entity Type:Organization
Organization Name:SUHAS JOSHI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUHAS
Authorized Official - Middle Name:VISHNU
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-708-2542
Mailing Address - Street 1:14346 BIG SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5167
Mailing Address - Country:US
Mailing Address - Phone:904-708-2542
Mailing Address - Fax:904-619-5228
Practice Address - Street 1:14346 BIG SPRING ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5167
Practice Address - Country:US
Practice Address - Phone:904-708-2542
Practice Address - Fax:904-619-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME730862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41996WMedicare PIN
FLG61295Medicare UPIN