1629062393 NPI number — RATNAMANI LINGAMALLU M.D.

Table of content: RATNAMANI LINGAMALLU M.D. (NPI 1629062393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629062393 NPI number — RATNAMANI LINGAMALLU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINGAMALLU
Provider First Name:
RATNAMANI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629062393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33802-1725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-683-5454
Provider Business Mailing Address Fax Number:
863-683-4652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 E GARDEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805-4615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-683-5454
Provider Business Practice Location Address Fax Number:
863-683-4652
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  ME66958 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: ME66958 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02827 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 375872900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 940583 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202794 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25818 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1095684-005 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 212107 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 625660 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 591452754B . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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