Provider Demographics
NPI:1659492148
Name:BISHNU P. VERMA MD, PA
Entity Type:Organization
Organization Name:BISHNU P. VERMA MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BISHNU
Authorized Official - Middle Name:PRAKASH
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-860-2600
Mailing Address - Street 1:1555 SAXON BLVD
Mailing Address - Street 2:601
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5861
Mailing Address - Country:US
Mailing Address - Phone:386-860-2600
Mailing Address - Fax:386-860-7216
Practice Address - Street 1:1555 SAXON BLVD
Practice Address - Street 2:601
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5861
Practice Address - Country:US
Practice Address - Phone:386-860-2600
Practice Address - Fax:386-860-7216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF82512Medicare UPIN
FL25299Medicare ID - Type Unspecified