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NPI Code Detail

MEDICARE: MANUS PRASERTHDAM,M.D.,P.A

MEDICARE: MANUS PRASERTHDAM,M.D.,P.A
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
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10666950OTHERFLAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30184828OTHERFLCIGNA
4212769OTHERFLAMERIGROUP
53106012OTHERFLUNITED HEALTHCARE

General Provider Information

NPI Number : 1376770826
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANUS PRASERTHDAM,M.D.,P.A
Provider Business Mailing Address
First Line : 1201 5TH AVE N STE 208
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33705-1410
Country : US
Telephone Number : 727-894-1122
Fax Number : 727-894-0033
Provider Business Practice Location Address
First Line : 1201 5TH AVE N STE 208
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33705-1410
Country : US
Telephone Number : 727-894-1122
Fax Number : 727-894-0033
Authorized Official
Title or Position : OWNER
Name : DR. MANUS PRASERTHDAM
Credential : M.D.
Telephone Number : 727-894-1122
Provider Enumeration Date : 06/11/2009
Last Update Date : 06/11/2009

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Directions to “MANUS PRASERTHDAM,M.D.,P.A ” Practice Location

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