Provider Demographics
NPI:1982651337
Name:THATTE, LALITA (MD)
Entity Type:Individual
Prefix:
First Name:LALITA
Middle Name:
Last Name:THATTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 TAMIAMI TRAIL
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8054
Mailing Address - Country:US
Mailing Address - Phone:941-629-4676
Mailing Address - Fax:941-629-1522
Practice Address - Street 1:3300 TAMIAMI TRAIL
Practice Address - Street 2:SUITE 101A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8054
Practice Address - Country:US
Practice Address - Phone:941-629-4676
Practice Address - Fax:941-629-1522
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064198207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250933400Medicaid
G30973Medicare UPIN
FL318772Medicare ID - Type Unspecified