Healthcare Provider Details

I. General information

NPI: 1780118141
Provider Name (Legal Business Name): JAY KAMDAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 TRAFALGAR CT STE 200E
MAITLAND FL
32751-7420
US

IV. Provider business mailing address

3600 FORBES AVE STE 140
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 321-422-7167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME155993
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME155993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: