Provider Demographics
NPI:1902805757
Name:LAMOTTA, EDWARD P (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:LAMOTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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:239-395-2444
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:33957-4402
Practice Address - Country:US
Practice Address - Phone:239-395-2444
Practice Address - Fax:239-395-2494
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74037207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93972Medicare UPIN
FL94636AMedicare PIN