=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912086075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOMAS J KATTA, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 02/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 922 LUCERNE TERRACE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-426-8660
-----------------------------------------------------
Fax | 407-426-6884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 922 LUCERNE TERRACE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-426-8660
-----------------------------------------------------
Fax | 407-426-6884
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. THOMAS J KATTA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-426-8660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | ME00
-----------------------------------------------------
License Number State |
-----------------------------------------------------