Provider Demographics
NPI:1245659010
Name:RATTAN, PAWAN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:PAWAN
Middle Name:KUMAR
Last Name:RATTAN
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 1:612 E DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3922
Mailing Address - Country:US
Mailing Address - Phone:813-222-2000
Mailing Address - Fax:
Practice Address - Street 1:612 E DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3922
Practice Address - Country:US
Practice Address - Phone:813-222-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40193207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology