Provider Demographics
NPI:1508199969
Name:I V S NATH MD FRCP PA
Entity Type:Organization
Organization Name:I V S NATH MD FRCP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IYYUNI
Authorized Official - Middle Name:V S
Authorized Official - Last Name:NATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-546-1680
Mailing Address - Street 1:PO BOX 25233
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5233
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-828-0723
Practice Address - Street 1:6217 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-546-1680
Practice Address - Fax:727-546-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47362207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065241500Medicaid
FL065241500Medicaid