Provider Demographics
NPI:1750594628
Name:RATHINASAMY, DILIP (MD)
Entity type:Individual
Prefix:DR
First Name:DILIP
Middle Name:
Last Name:RATHINASAMY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:307 S BUNGALOW PARK AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3159
Mailing Address - Country:US
Mailing Address - Phone:813-878-2020
Mailing Address - Fax:813-249-2020
Practice Address - Street 1:403 VONDERBURG DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5982
Practice Address - Country:US
Practice Address - Phone:813-681-1122
Practice Address - Fax:813-684-4924
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2020-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME98257207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000121500Medicaid