# VIJAY DIWADKAR,M.D.PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659672236
- **Authorized official:** DR. VIJAY DIWADKAR M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (813) 237-2500

## Contact information

- **Practice address:** 701 W M.L.KING JR. BLVD., SUITE 3, TAMPA, FL 33603-3100
- **Practice address phone:** (813) 237-2500
- **Practice address fax:** (813) 237-2871
- **Mailing address:** 701 W M.L.KING BLVD, SUITE 3, TAMPA, FL 33603-1922
- **Mailing address phone:** (813) 237-2500
- **Mailing address fax:** (813) 237-2871

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | ME39294 | FL | Yes |

## Other

- **Enumeration date:** 11/12/2010
- **Last updated:** 12/01/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 066699800 | — | FL |
| 01 | — | 30476 | BCBS | FL |