Provider Demographics
NPI:1306064381
Name:EDWARD P LAMOTTA MD PA
Entity type:Organization
Organization Name:EDWARD P LAMOTTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAMOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-395-2434
Mailing Address - Street 1:1699 PERIWINKLE WAY
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-4402
Mailing Address - Country:US
Mailing Address - Phone:239-395-2434
Mailing Address - Fax:239-395-2494
Practice Address - Street 1:1699 PERIWINKLE WAY
Practice Address - Street 2:
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957
Practice Address - Country:US
Practice Address - Phone:239-395-2434
Practice Address - Fax:239-395-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA93972Medicare UPIN
FLK6842Medicare PIN