MEDICARE: PLATINUM PRIMARY CARE PLLC

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

General Provider Information

NPI Number	:	1861007726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM PRIMARY CARE PLLC

Provider Business Mailing Address
First Line	:	2071 DUNDEE DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-4104
Country	:	US
Telephone Number	:	347-681-4136
Fax Number	:

Provider Business Practice Location Address
First Line	:	2071 DUNDEE DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-4104
Country	:	US
Telephone Number	:	347-681-4136
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	ASHA TOTA-MAHARAJ
Credential	:	MD
Telephone Number	:	347-681-4136

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	06/01/2021

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