Healthcare Provider Details

I. General information

NPI: 1700803657
Provider Name (Legal Business Name): GRACE V SARVOTHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MAIN ST
ALTAMONTE SPRINGS FL
32701-6413
US

IV. Provider business mailing address

918 CANTON ST
ORLANDO FL
32803-3207
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-6148
  • Fax: 407-339-0254
Mailing address:
  • Phone: 407-339-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME42498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: