1396179024 NPI number — ALBERT TAWIL, M.D., P.A.

Table of content: (NPI 1396179024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396179024 NPI number — ALBERT TAWIL, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBERT TAWIL, M.D., 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:
1396179024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 S HABANA AVE
Provider Second Line Business Mailing Address:
STE. 360
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33609-4181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-876-5548
Provider Business Mailing Address Fax Number:
813-874-2477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 S HABANA AVE
Provider Second Line Business Practice Location Address:
STE. 360
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-4181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-876-5548
Provider Business Practice Location Address Fax Number:
813-874-2477
Provider Enumeration Date:
08/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TAWIL
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSCIAN
Authorized Official Telephone Number:
813-876-5548

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X , with the licence number:  ME0010834 , 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: 014571900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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