Provider Demographics
NPI:1568450385
Name:BAY PEDIATRIC CARDIOLOGY INC
Entity Type:Organization
Organization Name:BAY PEDIATRIC CARDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-890-8004
Mailing Address - Street 1:2727 W MARTIN LUTHER KING BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-890-8004
Mailing Address - Fax:813-290-9691
Practice Address - Street 1:2727 W MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE 620
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-890-8004
Practice Address - Fax:813-290-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069549174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252702200Medicaid