Healthcare Provider Details

I. General information

NPI: 1710220314
Provider Name (Legal Business Name): RAMCHANDRA SIRAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ALAFAYA TRL STE 100
ORLANDO FL
32828
US

IV. Provider business mailing address

250 N ALAFAYA TRL STE 100
ORLANDO FL
32828-4316
US

V. Phone/Fax

Practice location:
  • Phone: 407-282-4400
  • Fax: 407-282-4191
Mailing address:
  • Phone: 407-282-4400
  • Fax: 407-282-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2228
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME138395
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberR2228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: