Individual
RAMA VAITLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7740 BOYNTON BEACH BLVD., BOYNTON BEACH, FL 33437
(561) 752-8000
(561) 752-8001
Mailing address
7740 BOYNTON BEACH BLVD, BOYNTON BEACH, FL 33437-3804
(561) 752-8000
(561) 752-8001
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME79506
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06957Y
MEDICARE PTAN
FL
Enumeration date
04/04/2006
Last updated
10/05/2015
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