MEDICARE: PRATHIMA MOORTHY 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	ME056744	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME056744	OTHER	FL	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164537973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATHIMA MOORTHY MD

Provider Business Mailing Address
First Line	:	4760 TAMIAMI TRAIL N
Second Line	:	SUITE 27
City	:	NAPLES
State	:	FL
Zip	:	34103
Country	:	US
Telephone Number	:	239-593-9594
Fax Number	:	239-593-4099

Provider Business Practice Location Address
First Line	:	4760 TAMIAMI TRAIL NORTH
Second Line	:	SUITE 27
City	:	NAPLES
State	:	FL
Zip	:	34109-3884
Country	:	US
Telephone Number	:	239-593-9594
Fax Number	:	239-593-4099

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	09/12/2016

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