Healthcare Provider Details

I. General information

NPI: 1366739575
Provider Name (Legal Business Name): PRAJWOL PATHAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 OCOEE APOPKA RD STE 230
APOPKA FL
32703-9210
US

IV. Provider business mailing address

1700 SPRING HILL AVE STE 100
MOBILE AL
36604-1416
US

V. Phone/Fax

Practice location:
  • Phone: 407-609-7510
  • Fax: 407-609-7511
Mailing address:
  • Phone: 251-435-1200
  • Fax: 251-435-6357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME132092
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number44389
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: