Provider Demographics
NPI:1720005721
Name:BAYSIDE UROLOGY PA
Entity Type:Organization
Organization Name:BAYSIDE UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-443-4505
Mailing Address - Street 1:501 S LINCOLN AVE
Mailing Address - Street 2:#11
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-443-4505
Mailing Address - Fax:727-441-9879
Practice Address - Street 1:501 S LINCOLN AVE
Practice Address - Street 2:#11
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-443-4505
Practice Address - Fax:727-441-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
38842Medicare ID - Type Unspecified