Healthcare Provider Details

I. General information

NPI: 1770780744
Provider Name (Legal Business Name): BAY AREA GYNECOLOGIC ONCOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5622 MARINE PKWY STE 18
NEW PORT RICHEY FL
34652-4333
US

IV. Provider business mailing address

PO BOX 409552
ATLANTA GA
30384-9552
US

V. Phone/Fax

Practice location:
  • Phone: 727-848-3944
  • Fax: 727-848-4441
Mailing address:
  • Phone: 727-823-2188
  • Fax: 727-823-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME87105
License Number StateFL

VIII. Authorized Official

Name: CHARLES SUGGS III
Title or Position: OWNER - PROVIDER
Credential: MD
Phone: 727-848-3944