Healthcare Provider Details

I. General information

NPI: 1295716645
Provider Name (Legal Business Name): RAMBABU TUMMALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9832 US HWY 441 SUITE 101
LEESBURG FL
34788
US

IV. Provider business mailing address

9832 US HWY 441 SUITE 101
LEESBURG FL
34788
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-3341
  • Fax: 352-787-7491
Mailing address:
  • Phone: 352-787-3341
  • Fax: 352-787-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME71127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: