MEDICARE: CTA ORAL PATHOLOGY CONSULTANTS OF FLORIDA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry

General Provider Information

NPI Number	:	1013864990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CTA ORAL PATHOLOGY CONSULTANTS OF FLORIDA PA

Provider Business Mailing Address
First Line	:	PO BOX 230577
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97281-0577
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 NW 43RD ST STE A
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-8100
Country	:	US
Telephone Number	:	503-906-7300
Fax Number	:	503-245-8219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	INDRANEEL BHATTACHARYYA
Credential	:
Telephone Number	:	352-262-8694

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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