Provider Demographics
NPI:1619956992
Name:MOTIRAM, VERONICA R (MD)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:R
Last Name:MOTIRAM
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 1:2240W WOOLBRIGHT RD 405
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6367
Mailing Address - Country:US
Mailing Address - Phone:561-364-0945
Mailing Address - Fax:561-364-1492
Practice Address - Street 1:2240W WOOLBRIGHT RD 405
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6367
Practice Address - Country:US
Practice Address - Phone:561-364-0945
Practice Address - Fax:561-364-1492
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00504192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07612OtherBCBS PROVIDER #
FL07612OtherBCBS PROVIDER #
E21376Medicare UPIN