Provider Demographics
NPI:1518955772
Name:INFECTIOUS DISEASES ASSOCIATES PA
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-366-9060
Mailing Address - Street 1:1425 S OSPREY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2938
Mailing Address - Country:US
Mailing Address - Phone:941-366-9060
Mailing Address - Fax:941-552-1588
Practice Address - Street 1:1425 S OSPREY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2938
Practice Address - Country:US
Practice Address - Phone:941-366-9060
Practice Address - Fax:941-552-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254868200Medicaid
FL21948OtherBCBS FL
FL254868200Medicaid
FLHQ194ZOtherRISHI BHATTACHAYYA MD MEDICARE PIN
FLD21056Medicare UPIN
FL03697YOtherANDREW H KRINSKY MD MEDICARE PIN
FLID434YOtherJASMINA A OUHRI PAC MEDICARE PIN
FL35640ZOtherROBERTO A MERCADO MD MEDICARE PIN
FLGV942YOtherMARIE V LANGONE ARNP MEDICARE PIN
FLIH418ZOtherJOSHUA A BEASLEY PAC MEDICARE PIN
FL21948OtherBCBS
FL26771ZOtherVILMA M VEGA MD MEDICARE PIN
FLE0513OtherSUDHA TALLAPRAGADA MD MEDICARE PIN
FLK0262Medicare PIN
FL17711WOtherMANUEL E GORDILLO MD MEDICARE PIN
FL23692XOtherJULIE A LARKIN MD MEDICARE PIN
FLG00948Medicare UPIN