Healthcare Provider Details

I. General information

NPI: 1285705004
Provider Name (Legal Business Name): MITCHELL B OHARA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 300
TAMPA FL
33613
US

IV. Provider business mailing address

3000 MEDICAL PARK DR STE 300
TAMPA FL
33613-4696
US

V. Phone/Fax

Practice location:
  • Phone: 813-497-9661
  • Fax: 813-615-8468
Mailing address:
  • Phone: 813-497-9661
  • Fax: 813-615-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS5698
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOS5698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: