Provider Demographics
NPI:1013221092
Name:DAVID R ANCONA MD PA
Entity Type:Organization
Organization Name:DAVID R ANCONA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANCONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-432-1771
Mailing Address - Street 1:603 N FLAMINGO RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-432-1771
Mailing Address - Fax:954-432-2722
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:SUITE 365
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-432-1771
Practice Address - Fax:954-432-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044382207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty