Provider Demographics
NPI:1356364525
Name:BRADENTON HEART CENTER P A
Entity type:Organization
Organization Name:BRADENTON HEART CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:T
Authorized Official - Last Name:RAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-794-3999
Mailing Address - Street 1:2010 59TH ST W
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4616
Mailing Address - Country:US
Mailing Address - Phone:941-794-3999
Mailing Address - Fax:941-792-4048
Practice Address - Street 1:2010 59TH ST W
Practice Address - Street 2:SUITE 4200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4616
Practice Address - Country:US
Practice Address - Phone:941-794-3999
Practice Address - Fax:941-792-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059046207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375960100Medicaid
FLDH2049OtherMEDICARE RAILROAD CARRIER
FLK4357Medicare ID - Type Unspecified
FLDH2049OtherMEDICARE RAILROAD CARRIER