Provider Demographics
NPI:1275584369
Name:MEDIRATTA, NIBHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIBHA
Middle Name:
Last Name:MEDIRATTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIBHA
Other - Middle Name:
Other - Last Name:KOHLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 991
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0985
Mailing Address - Country:US
Mailing Address - Phone:352-243-1101
Mailing Address - Fax:352-243-1134
Practice Address - Street 1:1970 HOSPITAL VIEW WAY
Practice Address - Street 2:UNIT 1
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1926
Practice Address - Country:US
Practice Address - Phone:352-243-1101
Practice Address - Fax:352-243-1134
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275258100Medicaid
G87648Medicare UPIN
FL275258100Medicaid