Provider Demographics
NPI:1023328135
Name:B ADHINARAYANAN MD PA
Entity type:Organization
Organization Name:B ADHINARAYANAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BALLAPURAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADHINARAYANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-613-1223
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-613-1223
Mailing Address - Fax:941-613-1224
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-613-1223
Practice Address - Fax:941-613-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36447207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08098Medicare PIN