MEDICARE: DR. RAMESH SOMAYAJULA AYYALA M.D.

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	207W00000X	Ophthalmology Physician	13072R	LA
2	207W00000X	Ophthalmology Physician	ME135486	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O9M6F	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356395404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAMESH SOMAYAJULA AYYALA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13127 USF MAGNOLIA DRIVE
Second Line	:	MDC 21
City	:	TAMPA
State	:	FL
Zip	:	33612-0000
Country	:	US
Telephone Number	:	813-974-2201
Fax Number	:

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	03/30/2021

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