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General NPI Number Information
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NPI Number | 1891751814
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Entity Type | Individual
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Provider Name | RAMCHANDRA NALLU M.D
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1920 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-2902
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Country | US
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Telephone | 863-683-4661
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 LAKE ELLEN DR
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City | TAMPA
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State | FL
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Zip | 33618-3617
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Country | US
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Telephone | 419-302-0888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35-077589N
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME141106
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License Number State | FL
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