MEDICARE: JODAN PATHINATHAN MD

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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	307633	NY
2	207K00000X	Allergy & Immunology Physician	ME176436	FL

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	:	1780112896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODAN PATHINATHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-9722
Fax Number	:	239-343-9725

Provider Business Practice Location Address
First Line	:	4761 S CLEVELAND AVE STE 3
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1375
Country	:	US
Telephone Number	:	239-343-9722
Fax Number	:	239-343-9725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2017
Last Update Date	:	02/05/2026

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