Provider Demographics
NPI:1225420722
Name:DELRAY PEDIATRICS
Entity Type:Organization
Organization Name:DELRAY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MALCOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-716-7783
Mailing Address - Street 1:4800 LINTON BLVD STE E315
Mailing Address - Street 2:87
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6585
Mailing Address - Country:US
Mailing Address - Phone:561-716-7783
Mailing Address - Fax:561-819-6003
Practice Address - Street 1:4800 LINTON BLVD STE E315
Practice Address - Street 2:87
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6585
Practice Address - Country:US
Practice Address - Phone:561-716-7783
Practice Address - Fax:561-819-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057708261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373118900Medicaid
FLF34362Medicare UPIN