MEDICARE: ORLANDO PRIMARY CARE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME76077	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336328012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO PRIMARY CARE PA

Provider Business Mailing Address
First Line	:	6200 SILVER STAR RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4245
Country	:	US
Telephone Number	:	407-298-0912
Fax Number	:	407-298-1750

Provider Business Practice Location Address
First Line	:	6200 SILVER STAR RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4245
Country	:	US
Telephone Number	:	407-298-0912
Fax Number	:	407-298-1750

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VENKATESWARA R NANDAM
Credential	:	M.D.
Telephone Number	:	407-298-0912

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	01/06/2013

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Directions to “ORLANDO PRIMARY CARE PA ” Practice Location

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