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General NPI Number Information
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NPI Number | 1467482414
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Entity Type | Individual
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Provider Name | SAMRAT V AMBEWADIKAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 10051 5TH ST N SUITE 200
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City | ST. PETERSBURG
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State | FL
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Zip | 33702-2211
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Country | US
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Telephone | 727-824-0780
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Fax | 813-514-8891
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Provider Business Mailing Address
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Address Line | 10051 5TH ST N SUITE 200
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City | ST PETERSBURG
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State | FL
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Zip | 33702-2289
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Country | US
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Telephone | 727-824-0780
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Fax | 813-514-8891
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME118532
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 234549
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License Number State | MA
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