MEDICARE: CHARLOTTE NEPHROLOGY ASSOCIATES 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	207RN0300X	Nephrology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144273541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE NEPHROLOGY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	3300 TAMIAMI TRAIL
Second Line	:	SUITE 101A
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8054
Country	:	US
Telephone Number	:	941-629-4676
Fax Number	:	941-629-1522

Provider Business Practice Location Address
First Line	:	3300 TAMIAMI TRL
Second Line	:	STE 101A
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8054
Country	:	US
Telephone Number	:	941-629-4676
Fax Number	:	941-629-1522

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	LALITA THATTE
Credential	:	MD
Telephone Number	:	941-629-4676

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/25/2010

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Directions to “CHARLOTTE NEPHROLOGY ASSOCIATES PA ” Practice Location

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