1285705004 NPI number — MITCHELL B OHARA DO

Table of content: MITCHELL B OHARA DO (NPI 1285705004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285705004 NPI number — MITCHELL B OHARA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OHARA
Provider First Name:
MITCHELL
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1285705004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 MEDICAL PARK DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33613-4696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-497-9661
Provider Business Mailing Address Fax Number:
813-615-8468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 MEDICAL PARK DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-497-9661
Provider Business Practice Location Address Fax Number:
813-615-8468
Provider Enumeration Date:
11/13/2006

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: 207RC0000X , with the licence number:  OS5698 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: OS5698 , 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: 592998397C . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 243268 . This is a "AUMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060033293 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 378982900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00658 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4661242 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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