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General NPI Number Information
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NPI Number | 1336328012
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Entity Type | Organization
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Legal Business Name | ORLANDO PRIMARY CARE PA
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 01/06/2013
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Provider Practice Location Address
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Address Line | 6200 SILVER STAR RD
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City | ORLANDO
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State | FL
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Zip | 32808-4245
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Country | US
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Telephone | 407-298-0912
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Fax | 407-298-1750
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Provider Business Mailing Address
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Address Line | 6200 SILVER STAR RD
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City | ORLANDO
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State | FL
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Zip | 32808-4245
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Country | US
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Telephone | 407-298-0912
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Fax | 407-298-1750
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VENKATESWARA R NANDAM
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Credential | M.D.
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Telephone | 407-298-0912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME76077
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License Number State | FL
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