MEDICARE: SUVARCHALA DEVI DARA 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	390200000X	Student in an Organized Health Care Education/Training Program	0101238389	VA
2	207RC0000X	Cardiovascular Disease Physician	ME105611	VA

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	:	1477764900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUVARCHALA DEVI DARA MD

Provider Business Mailing Address
First Line	:	PO BOX 781729
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32878-1729
Country	:	US
Telephone Number	:	407-480-4445
Fax Number	:	407-480-4446

Provider Business Practice Location Address
First Line	:	1111 S SEMORAN BLVD STE A
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1480
Country	:	US
Telephone Number	:	407-480-4445
Fax Number	:	407-480-4446

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	12/21/2020

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Directions to “ SUVARCHALA DEVI DARA MD” Practice Location

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