Provider Demographics
NPI:1780871830
Name:TITUSVILLE SURGICAL ASSOCIATES MD PA
Entity type:Organization
Organization Name:TITUSVILLE SURGICAL ASSOCIATES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMESHBHAI
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-267-4264
Mailing Address - Street 1:PO BOX 2727
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32781
Mailing Address - Country:US
Mailing Address - Phone:321-267-4264
Mailing Address - Fax:321-267-7012
Practice Address - Street 1:494 NORTH WASHINGTON AVENUE
Practice Address - Street 2:SUITE #2
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32781
Practice Address - Country:US
Practice Address - Phone:321-267-4264
Practice Address - Fax:321-267-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00624Medicare PIN