Provider Demographics
NPI:1669435004
Name:KAMATH, GEETHA J (MD)
Entity type:Individual
Prefix:
First Name:GEETHA
Middle Name:J
Last Name:KAMATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPARTMENT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:5767 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2107
Practice Address - Country:US
Practice Address - Phone:727-522-0558
Practice Address - Fax:727-521-3605
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME37660207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065324100Medicaid
FL065324100Medicaid
FL62287XMedicare PIN