Provider Demographics
NPI:1497856058
Name:MARIO MAGCALAS MD PA
Entity Type:Organization
Organization Name:MARIO MAGCALAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAME
Authorized Official - Middle Name:
Authorized Official - Last Name:MADALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-538-8543
Mailing Address - Street 1:10794 PINES BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3920
Mailing Address - Country:US
Mailing Address - Phone:954-538-8543
Mailing Address - Fax:954-431-8153
Practice Address - Street 1:10794 PINES BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3920
Practice Address - Country:US
Practice Address - Phone:954-538-8543
Practice Address - Fax:954-431-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117970000Medicaid
FL42429AOtherINDIVIDUAL MEDICARE PIN OLD #
FLF90792Medicare UPIN
FL4824210001Medicare NSC
FL42429AOtherINDIVIDUAL MEDICARE PIN OLD #