Provider Demographics
NPI:1093012049
Name:DOCTOR'S ASSOCIATES OF ORLANDO , LLC
Entity Type:Organization
Organization Name:DOCTOR'S ASSOCIATES OF ORLANDO , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRUDENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-557-8701
Mailing Address - Street 1:670 N ORLANDO AVE STE 1012
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4465
Mailing Address - Country:US
Mailing Address - Phone:407-790-7870
Mailing Address - Fax:407-790-7872
Practice Address - Street 1:670 N ORLANDO AVE STE 1012
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4465
Practice Address - Country:US
Practice Address - Phone:407-790-7870
Practice Address - Fax:407-790-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-26
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL11000021999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1093012049Medicare Oscar/Certification
FL1093012049Medicare PIN
FL1093012049Medicare UPIN
FL1093012049Medicare NSC