Healthcare Provider Details

I. General information

NPI: 1083655716
Provider Name (Legal Business Name): GURU P SONPAVDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 689
ORLANDO FL
32804-4648
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 689
ORLANDO FL
32804-4648
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2024
  • Fax:
Mailing address:
  • Phone: 407-303-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberL7567
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number271600
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number271600
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME154902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: