Healthcare Provider Details

I. General information

NPI: 1093701773
Provider Name (Legal Business Name): PRAVEEN KUMAR ROHATGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

2708 W VIRGINIA AVE
TAMPA FL
33607-6380
US

IV. Provider business mailing address

PO BOX 273512
TAMPA FL
33688-3512
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-7088
  • Fax:
Mailing address:
  • Phone: 813-875-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME47652
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME47652
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME47652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: