Provider Demographics
NPI:1780611764
Name:WASHINGTON, NIERMALA RATTAN (MD)
Entity type:Individual
Prefix:DR
First Name:NIERMALA
Middle Name:RATTAN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 NW 8TH AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3055
Mailing Address - Country:US
Mailing Address - Phone:954-783-0621
Mailing Address - Fax:954-783-0622
Practice Address - Street 1:3511 NW 8TH AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3055
Practice Address - Country:US
Practice Address - Phone:954-783-0621
Practice Address - Fax:954-783-0622
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90568207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271039100Medicaid
FLU3858BMedicare PIN
FLU3858CMedicare PIN
FLI21870Medicare UPIN
FLK7743Medicare PIN
FLU3858BMedicare PIN
FLU3858CMedicare ID - Type UnspecifiedFIRST COAST SERVICE OPTIO