Individual
MRS. PREMALA RAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
900 E PINE STREET, STE 215, ENGLEWOOD, FL 34223
(941) 475-5672
(941) 473-1456
Mailing address
900 E PINE STREET, STE 215, ENGLEWOOD, FL 34223
(941) 475-5672
(941) 473-1456
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME40190
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79881
BCBS
FL
01
—
P00050930
MEDICARE RAILROAD
FL
Enumeration date
08/10/2006
Last updated
03/05/2008
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