Provider Demographics
NPI:1871550483
Name:ATIGRE, PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:ATIGRE
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 1:5112 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6873
Mailing Address - Country:US
Mailing Address - Phone:813-374-2406
Mailing Address - Fax:813-374-2407
Practice Address - Street 1:5112 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6873
Practice Address - Country:US
Practice Address - Phone:813-374-2406
Practice Address - Fax:813-374-2407
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02722347Medicaid
NY0413105OtherINDEPENDENT HEALTH
NY000928785001OtherBC/BS WESTERN NEW YORK
NY180284BJOtherPREFERRED CARE
NY7467743OtherAETNA/RCIPA
NY00027393801OtherUNIVERA HEALTHCARE
NY060308000064OtherFIDELIS
NY2020237150OtherBC/BS TRADITIONAL
NYP010237150OtherEXCELLUS
NY7467743OtherAETNA/RCIPA
NY2020237150OtherBC/BS TRADITIONAL