Provider Demographics
NPI:1144496993
Name:ASHTA, RAMAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAMAN
Middle Name:
Last Name:ASHTA
Suffix:
Gender:F
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:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-253-2900
Mailing Address - Fax:321-435-0100
Practice Address - Street 1:1555 W NASA BLVD UNIT B1
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2640
Practice Address - Country:US
Practice Address - Phone:321-341-1700
Practice Address - Fax:321-622-6295
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117177207Q00000X
WI52835207Q00000X
PAMT188823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine