MEDICARE: DR. RAMAN ASHTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME117177	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144496993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMAN ASHTA MD

Provider Business Mailing Address
First Line	:	PO BOX 361095
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32936-1095
Country	:	US
Telephone Number	:	321-253-2900
Fax Number	:	321-435-0100

Provider Business Practice Location Address
First Line	:	1555 W NASA BLVD UNIT B1
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2640
Country	:	US
Telephone Number	:	321-341-1700
Fax Number	:	321-622-6295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	09/01/2021

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