Healthcare Provider Details

I. General information

NPI: 1902802325
Provider Name (Legal Business Name): RAMASWAMAIAH CHANDRASEKHARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N ALEXANDER ST UNIT 1
PLANT CITY FL
33563-3036
US

IV. Provider business mailing address

37908 DAUGHTERY RD SUITE A
ZEPHYRHILLS FL
33541-1316
US

V. Phone/Fax

Practice location:
  • Phone: 813-759-6607
  • Fax: 813-759-8997
Mailing address:
  • Phone: 813-780-8620
  • Fax: 813-780-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME32636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: