MEDICARE: ASTHMA ALLERGY AND IMMUNOLOGY OF TAMPA BAY 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	261QM2500X	Medical Specialty Clinic/Center	ME88573	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

General Provider Information

NPI Number	:	1982816716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASTHMA ALLERGY AND IMMUNOLOGY OF TAMPA BAY PA

Provider Business Mailing Address
First Line	:	1918 WEST MARTIN LUTHER KING JR. BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6504
Country	:	US
Telephone Number	:	813-873-1177
Fax Number	:	813-873-1166

Provider Business Practice Location Address
First Line	:	1918 W MARTIN L KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6510
Country	:	US
Telephone Number	:	813-873-1177
Fax Number	:	813-873-1166

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIANA PATRICIA MARTIN
Credential	:	M.D.
Telephone Number	:	813-873-1177

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	05/16/2012

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