Provider Demographics
NPI:1457450173
Name:TOSHNIWAL, LATA (MD)
Entity Type:Individual
Prefix:DR
First Name:LATA
Middle Name:
Last Name:TOSHNIWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 N ORANGE AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4639
Mailing Address - Country:US
Mailing Address - Phone:407-228-0220
Mailing Address - Fax:407-228-4668
Practice Address - Street 1:2909 N ORANGE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4639
Practice Address - Country:US
Practice Address - Phone:407-228-0220
Practice Address - Fax:407-228-4668
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00580382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252359100Medicaid
F72871Medicare UPIN
23686Medicare ID - Type Unspecified