Provider Demographics
NPI:1477942316
Name:BANCROFT MEDICAL
Entity Type:Organization
Organization Name:BANCROFT MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:O'HARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-923-5315
Mailing Address - Street 1:2111 W SWANN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2478
Mailing Address - Country:US
Mailing Address - Phone:813-253-5969
Mailing Address - Fax:813-253-5848
Practice Address - Street 1:2111 W SWANN AVE STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2478
Practice Address - Country:US
Practice Address - Phone:813-253-5969
Practice Address - Fax:813-253-5848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWANN MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty