Provider Demographics
NPI:1023004967
Name:UNIVERSITY MEDICAL CARE, PA
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-678-5656
Mailing Address - Street 1:471 N SEMORAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3803
Mailing Address - Country:US
Mailing Address - Phone:407-678-5656
Mailing Address - Fax:407-677-5550
Practice Address - Street 1:471 N SEMORAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3803
Practice Address - Country:US
Practice Address - Phone:407-678-5656
Practice Address - Fax:407-677-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74613OtherBLUE CROSS BLUE SHIELD
FL378531900Medicaid
FL378531900Medicaid