Provider Demographics
NPI:1871578294
Name:CHAMARTHY, LATHA M (MD)
Entity type:Individual
Prefix:DR
First Name:LATHA
Middle Name:M
Last Name:CHAMARTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5025
Mailing Address - Country:US
Mailing Address - Phone:727-544-8100
Mailing Address - Fax:727-544-8200
Practice Address - Street 1:6233 66TH STREET N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-544-8100
Practice Address - Fax:727-544-8200
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65838207K00000X, 2080P0201X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256994900Medicaid
FL256994901Medicaid
FL25263BMedicare ID - Type Unspecified
FL256994900Medicaid