Provider Demographics
NPI:1093900250
Name:EMERALD MEDICAL GROUP OF SARASOTA PA
Entity Type:Organization
Organization Name:EMERALD MEDICAL GROUP OF SARASOTA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-926-3100
Mailing Address - Street 1:3900 CLARK RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2301
Mailing Address - Country:US
Mailing Address - Phone:941-926-3100
Mailing Address - Fax:941-926-3200
Practice Address - Street 1:3900 CLARK RD
Practice Address - Street 2:SUITE B1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2301
Practice Address - Country:US
Practice Address - Phone:941-926-3100
Practice Address - Fax:941-926-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1586Medicare PIN