Provider Demographics
NPI:1861007726
Name:PLATINUM PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:PLATINUM PRIMARY CARE PLLC
Other - Org Name:PLATINUM PRIMARY CARE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTA-MAHARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-681-4136
Mailing Address - Street 1:2071 DUNDEE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4104
Mailing Address - Country:US
Mailing Address - Phone:347-681-4136
Mailing Address - Fax:
Practice Address - Street 1:2071 DUNDEE DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4104
Practice Address - Country:US
Practice Address - Phone:347-681-4136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty