Provider Demographics
NPI:1295716645
Name:TUMMALA, RAMBABU (MD)
Entity type:Individual
Prefix:
First Name:RAMBABU
Middle Name:
Last Name:TUMMALA
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 1:9832 US HWY 441
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788
Mailing Address - Country:US
Mailing Address - Phone:352-787-3341
Mailing Address - Fax:352-787-7491
Practice Address - Street 1:9832 US HWY 441
Practice Address - Street 2:SUITE 101
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788
Practice Address - Country:US
Practice Address - Phone:352-787-3341
Practice Address - Fax:352-787-7491
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71127207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
31507OtherBC BS
FL259000000Medicaid
830003186OtherRR MEDICARE
FL259000000Medicaid
830003186OtherRR MEDICARE