Provider Demographics
NPI:1720048051
Name:VERMA, BISHNU PRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:BISHNU
Middle Name:PRAKASH
Last Name:VERMA
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 1:1555 SAXON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5861
Mailing Address - Country:US
Mailing Address - Phone:386-860-2600
Mailing Address - Fax:386-860-2600
Practice Address - Street 1:1555 SAXON BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-860-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0064616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375599100Medicaid
FLF82512Medicare UPIN
FL375599100Medicaid
FL25299Medicare ID - Type Unspecified