1831412451 NPI number — CHARLOTTE NEPHROLOGY ASSOCIATES, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831412451 NPI number — CHARLOTTE NEPHROLOGY ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLOTTE NEPHROLOGY ASSOCIATES, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1831412451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 TAMIAMI TRL
Provider Second Line Business Mailing Address:
STE 101A
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33952-8054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-629-4676
Provider Business Mailing Address Fax Number:
941-629-1522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 N MILLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCADIA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34266-8780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-629-4676
Provider Business Practice Location Address Fax Number:
941-629-1522
Provider Enumeration Date:
03/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
THATTE
Authorized Official First Name:
LALITA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
941-629-4676

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  60708 , 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)





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