Provider Demographics
NPI:1447494802
Name:LAHAM, FEDERICO RICARDO (MD)
Entity type:Individual
Prefix:
First Name:FEDERICO
Middle Name:RICARDO
Last Name:LAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W GORE STREET
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1101
Mailing Address - Country:US
Mailing Address - Phone:321-841-7360
Mailing Address - Fax:321-841-7361
Practice Address - Street 1:60 W GORE STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1101
Practice Address - Country:US
Practice Address - Phone:321-841-7360
Practice Address - Fax:321-841-7361
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN26152080P0208X
FLME1072022080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME107202OtherMEDICAL LICENSE
FL002163200Medicaid
TX8L18180Medicare PIN
FLDF399ZMedicare PIN