1912086075 NPI number — THOMAS J KATTA, MD, PA

Table of content: (NPI 1912086075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912086075 NPI number — THOMAS J KATTA, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS J KATTA, MD, PA
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:
1912086075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
922 LUCERNE TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-426-8660
Provider Business Mailing Address Fax Number:
407-426-6884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
922 LUCERNE TERRACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-426-8660
Provider Business Practice Location Address Fax Number:
407-426-6884
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KATTA
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-426-8660

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  ME00 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ME0039331 . This is a "STATE LICENCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 069953500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com