Provider Demographics
NPI:1790110492
Name:BAPTIST DIABETES ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:BAPTIST DIABETES ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-613-8853
Mailing Address - Street 1:7867 N KENDALL DR
Mailing Address - Street 2:SUITE 80
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7742
Mailing Address - Country:US
Mailing Address - Phone:305-595-8252
Mailing Address - Fax:305-595-7958
Practice Address - Street 1:7867 N KENDALL DR
Practice Address - Street 2:SUITE 80
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7742
Practice Address - Country:US
Practice Address - Phone:305-595-8252
Practice Address - Fax:305-595-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014724207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty