Healthcare Provider Details

I. General information

NPI: 1114272184
Provider Name (Legal Business Name): JOSHUA LOTFALLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 SOUTHPARK CENTER LOOP STE 450
ORLANDO FL
32819-8647
US

IV. Provider business mailing address

9400 SOUTHPARK CENTER LOOP STE 450
ORLANDO FL
32819-8647
US

V. Phone/Fax

Practice location:
  • Phone: 689-282-6774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01077980A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME148388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: