Provider Demographics
NPI:1710169248
Name:BAY AREA NEPHROLOGY, PL
Entity Type:Organization
Organization Name:BAY AREA NEPHROLOGY, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:727-441-0104
Mailing Address - Street 1:1305 S FORT HARRISON AVE
Mailing Address - Street 2:BUILDING H
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3301
Mailing Address - Country:US
Mailing Address - Phone:727-441-0104
Mailing Address - Fax:727-441-8272
Practice Address - Street 1:1305 S FORT HARRISON AVE
Practice Address - Street 2:BUILDING H
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3301
Practice Address - Country:US
Practice Address - Phone:727-441-0104
Practice Address - Fax:727-441-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7262207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty