1982951687 NPI number — DR. ANDREA THOMAS DONALEXIS MD

Table of content: DR. ANDREA THOMAS DONALEXIS MD (NPI 1982951687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982951687 NPI number — DR. ANDREA THOMAS DONALEXIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONALEXIS
Provider First Name:
ANDREA
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS(BIRTH)RIVERS(FIRST MARRIAGE)
Provider Other First Name:
ANDREA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982951687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PINELLAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33756-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-462-7907
Provider Business Mailing Address Fax Number:
727-462-7904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 PINELLAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33756-3804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-462-7907
Provider Business Practice Location Address Fax Number:
727-462-7904
Provider Enumeration Date:
08/13/2012

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: 207Q00000X , with the licence number:  MD.33456 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME153060 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: MD60485834 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1982951687 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112566100 . 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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