Provider Demographics
NPI:1629062393
Name:LINGAMALLU, RATNAMANI (MD)
Entity type:Individual
Prefix:DR
First Name:RATNAMANI
Middle Name:
Last Name:LINGAMALLU
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 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:515 E GARDEN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4615
Practice Address - Country:US
Practice Address - Phone:863-683-5454
Practice Address - Fax:863-683-4652
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66958174400000X, 207K00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
212107OtherAVMED
940583OtherFIRST HEALTH
202794OtherAMERIGROUP
591452754BOtherHUMANA
FL625660OtherAETNA
02827OtherWELLCARE
25818OtherBCBS
FL375872900Medicaid
1095684-005OtherCIGNA
FLE62999Medicare UPIN
FL375872900Medicaid
FL625660OtherAETNA