Healthcare Provider Details

I. General information

NPI: 1962677666
Provider Name (Legal Business Name): DEVJIT HALDER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W BOUGAINVILLEA AVE
TAMPA FL
33612-7437
US

IV. Provider business mailing address

2600 S DOUGLAS RD STE 308
CORAL GABLES FL
33134-6134
US

V. Phone/Fax

Practice location:
  • Phone: 813-932-4381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME101166
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME101166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: