Provider Demographics
NPI:1831646900
Name:L BHATTACHARJEE MD PA
Entity Type:Organization
Organization Name:L BHATTACHARJEE MD PA
Other - Org Name:L BHATTACHARJEE MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMISRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATTACHARJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-542-5599
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-1428
Mailing Address - Country:US
Mailing Address - Phone:727-542-5599
Mailing Address - Fax:
Practice Address - Street 1:5826 LONG BAYOU WAY S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3530
Practice Address - Country:US
Practice Address - Phone:727-542-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266866100Medicaid
FL35571OtherFLORIDA BLUE CROSS BLUE SHIELD