Healthcare Provider Details

I. General information

NPI: 1770837189
Provider Name (Legal Business Name): PUJA KATHROTIYA KONDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 SE 18TH ST STE 1102
OCALA FL
34471-5447
US

IV. Provider business mailing address

1740 SE 18TH ST STE 1102
OCALA FL
34471-5447
US

V. Phone/Fax

Practice location:
  • Phone: 352-512-0092
  • Fax: 352-512-0093
Mailing address:
  • Phone: 352-512-0092
  • Fax: 352-512-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME124603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: