Provider Demographics
NPI:1316992175
Name:VALLABHAN, THIRUVALLUR ECCHAMBADI (MD)
Entity type:Individual
Prefix:MR
First Name:THIRUVALLUR
Middle Name:ECCHAMBADI
Last Name:VALLABHAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:929 N US HIGHWAY 441
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3001
Mailing Address - Country:US
Mailing Address - Phone:352-750-2040
Mailing Address - Fax:352-750-2060
Practice Address - Street 1:929 N US HIGHWAY 441
Practice Address - Street 2:SUITE 201
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3001
Practice Address - Country:US
Practice Address - Phone:352-750-2040
Practice Address - Fax:352-750-2060
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2015-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME81358207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDH97107Medicare UPIN