| Varghese Kodiyan Pa | |
|
602 Shellcracker Ct Tampa FL 33613 | |
| (813) 245-7326 | |
| Not Available |
| Full Name | Varghese Kodiyan Pa |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 05/15/2012 |
| Last Update Date | 05/15/2012 |
| Medicare PECOS PAC ID | 6204090426 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326084435 PECOS PAC ID: 6709040934 Enrollment ID: I20120619000504 |
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