Provider Demographics
NPI:1851312110
Name:AVAIYA, ASHOK G (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:G
Last Name:AVAIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHOKKUMAR
Other - Middle Name:G
Other - Last Name:AVAIYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:612 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6366
Mailing Address - Country:US
Mailing Address - Phone:813-977-9750
Mailing Address - Fax:813-977-9750
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0089257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2734320 00Medicaid
FL47719XOtherWELLMED PTAN
FLI14141Medicare UPIN
FL47719YMedicare ID - Type Unspecified