Provider Demographics
NPI:1255301982
Name:NUMRUNGROAD, VISAL (MD)
Entity type:Individual
Prefix:
First Name:VISAL
Middle Name:
Last Name:NUMRUNGROAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4738 GRAND BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5170
Mailing Address - Country:US
Mailing Address - Phone:727-848-1274
Mailing Address - Fax:727-849-6409
Practice Address - Street 1:4738 GRAND BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5170
Practice Address - Country:US
Practice Address - Phone:727-848-1274
Practice Address - Fax:727-849-6409
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0086087207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268824700Medicaid
FLU0949Medicare ID - Type Unspecified
FL268824700Medicaid