Provider Demographics
NPI:1053500702
Name:IRA G WARSHAW MDPA
Entity Type:Organization
Organization Name:IRA G WARSHAW MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WARSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MDPA
Authorized Official - Phone:561-626-1000
Mailing Address - Street 1:1216 US HIGHWAY 1
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3537
Mailing Address - Country:US
Mailing Address - Phone:561-626-1000
Mailing Address - Fax:561-630-5388
Practice Address - Street 1:1216 US HIGHWAY 1
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3537
Practice Address - Country:US
Practice Address - Phone:561-626-1000
Practice Address - Fax:561-630-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ5818Medicare PIN
FLK3227Medicare PIN