Provider Demographics
NPI:1770694416
Name:FLORIDA GASTROENTEROLOGY PA
Entity type:Organization
Organization Name:FLORIDA GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-895-9500
Mailing Address - Street 1:483 N SEMORAN BLVD
Mailing Address - Street 2:101
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-895-9500
Mailing Address - Fax:321-274-0266
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:101
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3803
Practice Address - Country:US
Practice Address - Phone:407-895-9500
Practice Address - Fax:321-274-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21610OtherBLUE CROSS BLUE SHIELD
FL21610Medicare ID - Type Unspecified