Healthcare Provider Details

I. General information

NPI: 1760587349
Provider Name (Legal Business Name): PRIMARY CARE PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 S HIAWASSEE RD STE# 105
ORLANDO FL
32835-5718
US

IV. Provider business mailing address

1507 S HIAWASSEE RD STE# 105
ORLANDO FL
32835-5718
US

V. Phone/Fax

Practice location:
  • Phone: 407-445-9224
  • Fax: 407-445-6236
Mailing address:
  • Phone: 407-445-9224
  • Fax: 407-445-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REVATI D NARAHARI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-445-9224