Provider Demographics
NPI:1225209919
Name:NIERMALA RATTAN-WASHINGTON,M.D.,P.A.
Entity Type:Organization
Organization Name:NIERMALA RATTAN-WASHINGTON,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIERMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954288-448-1481
Mailing Address - Street 1:2137 SEA PINES WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7738
Mailing Address - Country:US
Mailing Address - Phone:954-288-4481
Mailing Address - Fax:954-783-0622
Practice Address - Street 1:3511 NW 8TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3055
Practice Address - Country:US
Practice Address - Phone:954-783-0621
Practice Address - Fax:954-255-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271039100Medicaid
FLK7743Medicare PIN
FLK7868Medicare PIN
FLK7743Medicare PIN