Provider Demographics
NPI:1518605955
Name:MDLIVE MEDICAL GROUP DE PA
Entity Type:Organization
Organization Name:MDLIVE MEDICAL GROUP DE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR PROVIDER SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-400-6354
Mailing Address - Street 1:3350 SW 148TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3350 SW 148TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3259
Practice Address - Country:US
Practice Address - Phone:800-400-6354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDLIVE MEDICAL GROUP DE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-25
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty