Provider Demographics
NPI:1518942473
Name:NAKAGAWA, THOMAS ALAN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:NAKAGAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:DEPT #6580070302
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-4429
Mailing Address - Fax:727-767-8526
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:DEPT #6580070302
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-4429
Practice Address - Fax:727-767-8526
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1271122080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
49015OtherPARTNERS
7356642OtherAETNA
WV9840886000Medicaid
FL016874600Medicaid
B5785OtherMEDCOST
NC891307HMedicaid
1307HOtherBCBS
VA6736611Medicaid
NC2003100Medicare PIN