Provider Demographics
NPI:1093757262
Name:RATHORE, ALIYA (MD)
Entity Type:Individual
Prefix:
First Name:ALIYA
Middle Name:
Last Name:RATHORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 ASHLEY OAKS CIR
Mailing Address - Street 2:STE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6417
Mailing Address - Country:US
Mailing Address - Phone:813-994-8481
Mailing Address - Fax:813-994-8381
Practice Address - Street 1:2106 ASHEY OAK CIRCLE
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543
Practice Address - Country:US
Practice Address - Phone:813-994-8481
Practice Address - Fax:813-994-8381
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH54720Medicare UPIN
08262Medicare ID - Type Unspecified