Provider Demographics
NPI:1891792453
Name:SWAMINATHAN, RENUKA (MD PA)
Entity Type:Individual
Prefix:
First Name:RENUKA
Middle Name:
Last Name:SWAMINATHAN
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SE 17TH ST
Mailing Address - Street 2:STE 504
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5176
Mailing Address - Country:US
Mailing Address - Phone:352-629-2250
Mailing Address - Fax:352-629-0056
Practice Address - Street 1:150 SE 17TH ST
Practice Address - Street 2:STE 504
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5176
Practice Address - Country:US
Practice Address - Phone:352-629-2250
Practice Address - Fax:352-629-0056
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2009-05-28
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
FLME77982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261003500Medicaid
FL261003500Medicaid
35371Medicare PIN