=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578523445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULMONARY MEDICAL ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2006
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1576 SE PORT ST LUCIE BLVD
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-5450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-353-8313
-----------------------------------------------------
Fax | 772-879-9636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1576 SE PORT ST LUCIE BLVD
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-5450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-353-8313
-----------------------------------------------------
Fax | 772-879-9636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RAMESH NAYYAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 772-461-4834
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME39359
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | ME30367
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------