1962933598 NPI number — SHAARA KATHERINE BARRON M.D.

Table of content: SHAARA KATHERINE BARRON M.D. (NPI 1962933598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962933598 NPI number — SHAARA KATHERINE BARRON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRON
Provider First Name:
SHAARA
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARGO
Provider Other First Name:
SHAARA
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962933598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 917770
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:
32891-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-974-2201
Provider Business Mailing Address Fax Number:
813-974-2812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 DAVIS BLVD # 259-8725
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33606-3475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-259-8725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME144778 , 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: 106639400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: MR348 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: QX1JH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 106639400 . 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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