Provider Demographics
NPI:1144271628
Name:TERVO, RUPA D (MD)
Entity type:Individual
Prefix:DR
First Name:RUPA
Middle Name:D
Last Name:TERVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:RUPA
Other - Middle Name:D
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:23110 STATE ROAD 54 STE 167
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6933
Mailing Address - Country:US
Mailing Address - Phone:727-946-4443
Mailing Address - Fax:
Practice Address - Street 1:20815 BROADWATER DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-8318
Practice Address - Country:US
Practice Address - Phone:727-946-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85349207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280137000Medicaid
FL10732842OtherCAQH
FL10732842OtherCAQH
FL134761Medicare PIN
FL280137000Medicaid