1790837086 NPI number — LAKSHMISRI BHATTACHARJEE MD

Table of content: LAKSHMISRI BHATTACHARJEE MD (NPI 1790837086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790837086 NPI number — LAKSHMISRI BHATTACHARJEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHATTACHARJEE
Provider First Name:
LAKSHMISRI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790837086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINELLAS PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33780-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-542-5599
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5826 LONG BAYOU WAY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33708-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-542-5599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  ME79890 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3594800 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 35571 . This is a "BLUE CROSS BLUE SHEILD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3563524 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N233149 . This is a "WELL CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266866100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC1527 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 48-01008 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: N233149 . This is a "PINELLAS COUNTY HUMAN SER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11230301 . This is a "CITRUS HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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