Provider Demographics
NPI:1659379352
Name:HITAWALA, SALMA (MD)
Entity Type:Individual
Prefix:
First Name:SALMA
Middle Name:
Last Name:HITAWALA
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:PO BOX 1609
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-1609
Mailing Address - Country:US
Mailing Address - Phone:407-625-3635
Mailing Address - Fax:407-345-9966
Practice Address - Street 1:3105 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6892
Practice Address - Country:US
Practice Address - Phone:352-404-7874
Practice Address - Fax:352-988-6460
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256056900Medicaid
FL256056900Medicaid
FL44924YMedicare PIN