Varghese Kodiyan Pa | |
602 Shellcracker Ct Tampa FL 33613 | |
(813) 245-7326 | |
Not Available |
Full Name | Varghese Kodiyan Pa |
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Speciality | Social Worker |
Location | 602 Shellcracker Ct, Tampa, Florida |
Authorized Official Name and Position | Varghese Kodiyan (PRESIDENT) |
Authorized Official Contact | 8132457326 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Varghese Kodiyan Pa 602 Shellcracker Ct Tampa FL 33613-1214 Ph: (813) 245-7326 | Varghese Kodiyan Pa 602 Shellcracker Ct Tampa FL 33613 Ph: (813) 245-7326 |
NPI Number | 1003175753 |
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Provider Enumeration Date | 05/15/2012 |
Last Update Date | 05/15/2012 |
Medicare PECOS PAC ID | 6204090426 |
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Medicare Enrollment ID | O20120619000308 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003175753 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Varghese Kodiyan |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1326084435 PECOS PAC ID: 6709040934 Enrollment ID: I20120619000504 |
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