Provider Demographics
NPI:1962677666
Name:HALDER, DEVJIT (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVJIT
Middle Name:
Last Name:HALDER
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 1:3102 W CYPRESS ST STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5118
Mailing Address - Country:US
Mailing Address - Phone:813-875-3444
Mailing Address - Fax:813-878-2110
Practice Address - Street 1:3102 W CYPRESS ST STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5118
Practice Address - Country:US
Practice Address - Phone:813-875-3444
Practice Address - Fax:813-878-2110
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101166207R00000X, 173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherDOES NOT HAVE ANY OF THE ABOVE NOW APPLYING