Basic Information
| Provider Information | |||||||||
| NPI: | 1790721165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUMALLA | ||||||||
| FirstName: | ASHWIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 SE 18TH AVE | ||||||||
| Address2: | BLDG #400 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344718215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527328905 | ||||||||
| FaxNumber: | 3527322440 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 SE 18TH AVE | ||||||||
| Address2: | BLDG #400 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344718215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527328905 | ||||||||
| FaxNumber: | 3527322440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME84488 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 263693000 | 05 | FL | MEDICAID |