MEDICARE: BAY COMMUNITY PEDIATRICS 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	208000000X	Pediatrics Physician	ME39612	FL

General Provider Information

NPI Number	:	1457660037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY COMMUNITY PEDIATRICS PA

Provider Business Mailing Address
First Line	:	5600 MARINER ST
Second Line	:	SUITE 200
City	:	TAMPA
State	:	FL
Zip	:	33609-3471
Country	:	US
Telephone Number	:	813-506-6080
Fax Number	:	813-506-6090

Provider Business Practice Location Address
First Line	:	7108 N NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-4915
Country	:	US
Telephone Number	:	813-239-3262
Fax Number	:	813-506-6090

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PALLAVI PATEL
Credential	:	MD
Telephone Number	:	813-506-6080

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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