Provider Demographics
NPI:1609897842
Name:PITRODA, PARAG (MD)
Entity type:Individual
Prefix:
First Name:PARAG
Middle Name:
Last Name:PITRODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQUARE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:13417 US HWY 301 S
Practice Address - Street 2:SUITE A
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:352-567-5136
Practice Address - Fax:813-355-5038
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110070394OtherRR MEDICARE
FL373325400Medicaid
FL110070394OtherRR MEDICARE
FL23259ZMedicare PIN