Provider Demographics
NPI:1356519011
Name:MAIN STREET MEDICAL PA
Entity type:Organization
Organization Name:MAIN STREET MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PATLIN
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-734-0555
Mailing Address - Street 1:1121 OVERCASH DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5522
Mailing Address - Country:US
Mailing Address - Phone:727-734-0555
Mailing Address - Fax:727-736-4304
Practice Address - Street 1:1121 OVERCASH DRIVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5522
Practice Address - Country:US
Practice Address - Phone:727-734-0555
Practice Address - Fax:727-736-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty