Provider Demographics
NPI:1770780744
Name:BAY AREA GYNECOLOGIC ONCOLOGY PA
Entity type:Organization
Organization Name:BAY AREA GYNECOLOGIC ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGGS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:727-848-3944
Mailing Address - Street 1:PO BOX 409552
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-9552
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-823-9502
Practice Address - Street 1:5622 MARINE PKWY
Practice Address - Street 2:STE 18
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4333
Practice Address - Country:US
Practice Address - Phone:727-848-3944
Practice Address - Fax:727-848-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87105207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
78696Medicare ID - Type Unspecified