Provider Demographics
NPI:1811952443
Name:RATHINAM, ANANTHI (MD)
Entity type:Individual
Prefix:
First Name:ANANTHI
Middle Name:
Last Name:RATHINAM
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 1:10931 DYLAN LOREN CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4449
Mailing Address - Country:US
Mailing Address - Phone:407-218-4444
Mailing Address - Fax:321-284-1514
Practice Address - Street 1:10931 DYLAN LOREN CIR
Practice Address - Street 2:UNIT A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825
Practice Address - Country:US
Practice Address - Phone:407-218-4444
Practice Address - Fax:321-284-1514
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94141174400000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273514800Medicaid
FL29498OtherBCBS