Provider Demographics
NPI:1477799104
Name:HINA AZMAT MD PA
Entity Type:Organization
Organization Name:HINA AZMAT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZMAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-259-9902
Mailing Address - Street 1:770 DELTONA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7168
Mailing Address - Country:US
Mailing Address - Phone:386-259-9902
Mailing Address - Fax:407-218-8901
Practice Address - Street 1:770 DELTONA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7168
Practice Address - Country:US
Practice Address - Phone:386-259-9902
Practice Address - Fax:407-218-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI51990Medicare UPIN