Organization
GULF COAST ALLERGY CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. USHA CHANDRAHASA M.D. (PHYSICIAN)
(941) 743-2277
Entity
Organization
Contact information
Practice address
3400 TAMIAMI TRL, SUITE 201, PORT CHARLOTTE, FL 33952-8102
(941) 743-2277
(941) 743-2275
Mailing address
PO BOX 494507, PORT CHARLOTTE, FL 33949-4507
(941) 743-2277
(941) 743-2275
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
ME84695
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17055
BCBS FL
FL
Enumeration date
08/20/2006
Last updated
10/22/2007
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