MEDICARE: DR. VENKATESWARA R NANDAM M.D.

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	ME 76077	FL

General Provider Information

NPI Number	:	1669444626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATESWARA R NANDAM M.D.

Provider Business Mailing Address
First Line	:	6388 SILVER STAR RD
Second Line	:	STE# 1C
City	:	ORLANDO
State	:	FL
Zip	:	32818-3235
Country	:	US
Telephone Number	:	407-298-0912
Fax Number	:

Provider Business Practice Location Address
First Line	:	6388 SILVER STAR RD
Second Line	:	STE# 1C
City	:	ORLANDO
State	:	FL
Zip	:	32818-3235
Country	:	US
Telephone Number	:	407-298-0912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	11/30/2007

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