Healthcare Provider Details

I. General information

NPI: 1427161181
Provider Name (Legal Business Name): ADVANCED ALLERGY & ASTHMA CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 66TH ST NORTH
PINELLAS PARK FL
33781-5025
US

IV. Provider business mailing address

6233 66TH ST NORTH
PINELLAS PARK FL
33781-5025
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-8100
  • Fax: 727-544-8200
Mailing address:
  • Phone: 727-544-8100
  • Fax: 727-544-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME65838
License Number StateFL

VIII. Authorized Official

Name: DR. LATHA M CHAMARTHY
Title or Position: PRESIDENT
Credential: MD
Phone: 727-544-8100