Provider Demographics
NPI:1992853493
Name:P NATARAJAN,M.D.,P.A.
Entity Type:Organization
Organization Name:P NATARAJAN,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PONNUSWAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NATARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-917-8666
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:STE 301
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-917-8666
Mailing Address - Fax:941-917-8829
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:STE 301
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-8666
Practice Address - Fax:941-917-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059253600Medicaid
FL059253600Medicaid
FLD56908Medicare UPIN