Provider Demographics
NPI:1912012642
Name:CHARLOTTE HARBOR ANESTHESIA PA
Entity Type:Organization
Organization Name:CHARLOTTE HARBOR ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TORTORICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-823-2188
Mailing Address - Street 1:PO BOX 20042
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33742-0042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3637 4TH ST N
Practice Address - Street 2:STE 400
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1355
Practice Address - Country:US
Practice Address - Phone:727-823-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94973OtherBCBS
FLDD6596OtherRR MEDICARE
FL94973Medicare ID - Type Unspecified