Provider Demographics
NPI:1932101201
Name:MARANDI, HOSSAIN M (MD)
Entity Type:Individual
Prefix:
First Name:HOSSAIN
Middle Name:M
Last Name:MARANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 EISENHOWER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-286-8835
Practice Address - Street 1:2550 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6302
Practice Address - Country:US
Practice Address - Phone:813-876-4902
Practice Address - Fax:813-876-0472
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266128400Medicaid
FL57912YMedicare PIN
FLH79353Medicare UPIN