MEDICARE: 53RD AVE. EAST MEDICAL CENTER, 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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1518929389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	53RD AVE. EAST MEDICAL CENTER, P.A.

Provider Business Mailing Address
First Line	:	712 53RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-5827
Country	:	US
Telephone Number	:	941-755-2456
Fax Number	:	941-932-4795

Provider Business Practice Location Address
First Line	:	712 53RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-5827
Country	:	US
Telephone Number	:	941-755-2456
Fax Number	:	941-932-4795

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PADMINI RAJAN
Credential	:	M.D.
Telephone Number	:	941-755-2456

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	08/22/2020

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