JACOB K AGAMASU MD PA (NPI# 1629151683) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629151683 |
| Entity Type | Organization |
| Organization Name | JACOB K AGAMASU MD PA |
| Practice Address |
1355 S International Pkwy Suite 1481 Lake Mary FL 32746-1694 |
| Practice Telephone | 4078049616 |
| Practice Fax Number | 4078048331 |
| Mailing Telephone | 4078049616 |
| Mailing Fax Number | 4078048331 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2008-04-07 |
| Authorized Official Name | DR. JACOB K AGAMASU (OWNER) |
| Authorized Official Telephone | 4078049616 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS | 13045 | 01 |
| FL | WELLCARE | 202573 | 01 |
| Street Address |
1355 S INTERNATIONAL PKWY SUITE 1481 |
| City | LAKE MARY |
| State | FL |
| Zip Code | 32746-1694 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598706442 | Balinder S Chahal | Psychiatry & Neurology | 1355 S International Pkwy, Ste.2491, Lake Mary, FL 32746-1696 | 2006-06-10 |
| 1760882617 | Neurology & Neurodiagnostics LLC | Psychiatry & Neurology | 1355 S International Pkwy, Suite 2451, Lake Mary, FL 32746-1694 | 2014-08-28 |
| 1790100873 | Advanced Heart and Vascular Medicine, Inc. | Internal Medicine | 1355 S International Pkwy, Suite 1481, Lake Mary, FL 32746-1694 | 2014-02-26 |
| 1174862882 | Rebecca C Villar | Clinical Neuropsychologist | 1355 S International Pkwy, Ste 2471, Lake Mary, FL 32746-1694 | 2013-02-01 |
| 1831421403 | Jorge Gomez Md Pa | Internal Medicine | 1355 S International Pkwy, 1451, Lake Mary, FL 32746-1694 | 2010-02-08 |
| 1942345624 | Balinder S. Chahal, Md. P.a. | Psychiatry & Neurology | 1355 S International Pkwy, Suite 2491, Lake Mary, FL 32746-1694 | 2007-02-21 |
| 1104909647 | Juan Ros-escalante | Psychiatry & Neurology | 1355 S International Pkwy, Suite 2451, Lake Mary, FL 32746-1694 | 2006-10-20 |
| 1396754172 | Jorge O Diaz Md Pa | Internal Medicine | 1355 S International Pkwy, Suite 1451, Lake Mary, FL 32746-1694 | 2006-08-07 |
| 1487663373 | Jorge O. Diaz | Internal Medicine | 1355 S International Pkwy, Suite 1451, Lake Mary, FL 32746-1694 | 2006-08-07 |
| 1194767467 | Balinder S. Chahal, Md., Pa | Psychiatry & Neurology | 1355 S International Pkwy, #2491, Lake Mary, FL 32746-1696 | 2006-06-12 |
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|---|---|---|---|---|
| 1588286397 | James Maggert | Physical Therapist | Sst Rehab, 635 Century Pt - Suite 111, Lake Mary, FL 32746 | 2020-05-14 |
| 1225663743 | Jamie Pecot | Behavior Technician | 300 International Parkway, 200, Lake Mary, FL 32746 | 2020-03-04 |
| 1619509585 | Dental Associates of Heathrow, LLC | Dentist | Dental Associates of Heathrow, LLC, 120 International Parkway Suite 26, Heathrow, FL 32746 | 2020-02-10 |
| 1376185876 | Rinehart Road Surgery Center, LLC | Clinic/Center | 392 Rinehart Road, Suite 1100, Lake Mary, FL 32746 | 2019-10-16 |
| 1871140988 | Central Florida Wellness LLC | General Practice | 1061 S Sun Drove, Suite 1041, Lake. Mary, FL 32746 | 2019-08-22 |
| 1326609942 | Antoine Slade I | Behavior Technician | 4876 Rhinehart Road, Lake Mary, FL 32746 | 2019-06-25 |
| 1245891209 | Ohri, LLC | Clinic/Center | 392 Rinehart Rd., Suite 1300, Lake Mary, FL 32746 | 2019-06-21 |
| 1336610856 | Olivia Laurel Stolz | Physician Assistant | 3300 West Lake Mary Blvd, 220, Lake Mary, FL 32746 | 2018-12-10 |
| 1881171072 | Elite-star Medical Transport LLC. | Non-emergency Medical Transport (VAN) | 2910 W Lake Mary Blvd Ste 101, Lake Mary, FL 32746 | 2018-07-20 |
| 1508351537 | Ariagny Elena Fereira | Speech-Language Pathologist | 145 Middle Street Suite 1101, Lake Mary, FL 32746 | 2018-06-22 |
| Find all providers in zip 32746 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194774604 | Jacob K Agamasu | Internal Medicine | 1355 S International Parkway, Ste 1481, Lake Mary, FL 32746-1694 | 2006-05-10 |
| 1568443356 | Jorge Gomez | Internal Medicine | 1355 South International Parkway, Suite 1451, Lake Mary, FL 32746-1694 | 2005-11-08 |
| 1346627650 | Opa Physician Partners, Pllc | Internal Medicine | 1540 International Pkwy, Suite 2000, Lake Mary, FL 32746-5096 | 2015-05-06 |
| 1790100873 | Advanced Heart and Vascular Medicine, Inc. | Internal Medicine | 1355 S International Pkwy, Suite 1481, Lake Mary, FL 32746-1694 | 2014-02-26 |
| 1831421403 | Jorge Gomez Md Pa | Internal Medicine | 1355 S International Pkwy, 1451, Lake Mary, FL 32746-1694 | 2010-02-08 |
| 1710084199 | Lawrence E Vallario | Internal Medicine | 910 Williston Park Pt, Ste 1000, Lake Mary, FL 32746-2163 | 2006-09-20 |
| 1851497242 | William J David | Internal Medicine | 910 Williston Park Pt, Ste 1000, Lake Mary, FL 32746-2172 | 2006-09-15 |
| 1427154756 | Carlos P Grullon | Internal Medicine | 910 Williston Park Pt, Ste 1000, Lake Mary, FL 32746-2172 | 2006-09-15 |
| 1275639544 | Wilberto L Lopez | Internal Medicine | 910 Williston Park Pt, Ste 1000, Lake Mary, FL 32746-2172 | 2006-09-15 |
| 1396795928 | Jay B Bitar | Internal Medicine | 1355 S International Parkway, Ste 1481, Lake Mary, FL 32746-1694 | 2006-05-12 |
| Find all providers in LAKE MARY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.