Provider Demographics
NPI:1477742799
Name:GEORGE M NORTHRUP M D P A
Entity type:Organization
Organization Name:GEORGE M NORTHRUP M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NORTHRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-350-9500
Mailing Address - Street 1:5100 W KENNEDY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1817
Mailing Address - Country:US
Mailing Address - Phone:813-350-9500
Mailing Address - Fax:813-350-9544
Practice Address - Street 1:5100 W KENNEDY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1817
Practice Address - Country:US
Practice Address - Phone:813-350-9500
Practice Address - Fax:813-350-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG96872Medicare UPIN