Provider Demographics
NPI:1790942555
Name:PADALA, SMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SMITA
Middle Name:
Last Name:PADALA
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 1:20450 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-6030
Mailing Address - Country:US
Mailing Address - Phone:352-270-5441
Mailing Address - Fax:352-489-5333
Practice Address - Street 1:20450 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-6030
Practice Address - Country:US
Practice Address - Phone:352-533-4422
Practice Address - Fax:352-489-5333
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA239463207RN0300X
FLME112575207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology