Healthcare Provider Details

I. General information

NPI: 1669405841
Provider Name (Legal Business Name): PHILIP CRAIG OVADIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 37TH AVE N # 289
ST PETERSBURG FL
33704-1416
US

IV. Provider business mailing address

204 37TH AVE N # 289
ST PETERSBURG FL
33704-1416
US

V. Phone/Fax

Practice location:
  • Phone: 727-472-9995
  • Fax: 727-351-8042
Mailing address:
  • Phone: 617-480-6639
  • Fax: 727-351-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME132749
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD426935
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD426935
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: