Provider Demographics
NPI:1912932138
Name:PEDIATRIC GASTROENTEROLOGY OF CENTRAL FLORIDA PA
Entity Type:Organization
Organization Name:PEDIATRIC GASTROENTEROLOGY OF CENTRAL FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANGEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARGAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-898-1210
Mailing Address - Street 1:PO BOX 691594
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869
Mailing Address - Country:US
Mailing Address - Phone:407-898-1210
Mailing Address - Fax:407-898-2909
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 510
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-898-1210
Practice Address - Fax:407-898-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME677682080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278363100Medicaid
FLG04114Medicare UPIN
FLK1566Medicare PIN