Provider Demographics
NPI:1699009043
Name:THOTA, VENKATA RAM PRASAD (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA RAM PRASAD
Middle Name:
Last Name:THOTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:FLORIDA HOSPITAL FLAGLER INPATIENT PARTNERS
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5980
Mailing Address - Country:US
Mailing Address - Phone:386-586-4743
Mailing Address - Fax:386-586-4740
Practice Address - Street 1:60 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:FLORIDA HOSPITAL FLAGLER INPATIENT PARTNERS
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5980
Practice Address - Country:US
Practice Address - Phone:386-586-4743
Practice Address - Fax:386-586-4740
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067621207R00000X
FLME111847207R00000X
IL125.055607207R00000X
TXT5474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine