Healthcare Provider Details

I. General information

NPI: 1861195620
Provider Name (Legal Business Name): CITRUS HOSPITALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N SUNCOAST BLVD
CRYSTAL RIVER FL
34428-6712
US

IV. Provider business mailing address

3600 N GRAYHAWK LOOP
LECANTO FL
34461-8468
US

V. Phone/Fax

Practice location:
  • Phone: 732-335-6512
  • Fax: 732-305-8026
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAKRADHAR DESARAJU
Title or Position: OWNER
Credential: MD
Phone: 352-601-2375