MEDICARE: PRINTHA MD INTERNAL MEDICINE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1679120471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINTHA MD INTERNAL MEDICINE INC

Provider Business Mailing Address
First Line	:	5420 WEBB RD STE B1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3255
Country	:	US
Telephone Number	:	813-882-4424
Fax Number	:

Provider Business Practice Location Address
First Line	:	5420 WEBB RD STE B1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3255
Country	:	US
Telephone Number	:	813-882-4424
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SRIPRINTHA NAVARATHINARAJAH
Credential	:	MD
Telephone Number	:	813-882-4424

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	08/26/2019

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