Provider Demographics
NPI:1861428062
Name:AMANOLLAH TABESH MD PA
Entity type:Organization
Organization Name:AMANOLLAH TABESH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TABESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-932-0804
Mailing Address - Street 1:7001 N DALE MABRY HWY
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3910
Mailing Address - Country:US
Mailing Address - Phone:813-932-0804
Mailing Address - Fax:813-932-8163
Practice Address - Street 1:7001 N DALE MABRY HWY
Practice Address - Street 2:SUITE # 3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3910
Practice Address - Country:US
Practice Address - Phone:813-932-0804
Practice Address - Fax:813-932-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41543261Q00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85575Medicare UPIN
FL30792Medicare ID - Type Unspecified