Provider Demographics
NPI:1942254412
Name:TALATI, RAJA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:R
Last Name:TALATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3255 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6381
Mailing Address - Country:US
Mailing Address - Phone:772-742-9270
Mailing Address - Fax:772-772-3354
Practice Address - Street 1:1801 SE HILLMOOR DR STE C-207
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7574
Practice Address - Country:US
Practice Address - Phone:772-742-9270
Practice Address - Fax:772-335-4236
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 87361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81394YMedicare PIN