Provider Demographics
NPI:1558450221
Name:ANWAR VARDAG MD PA
Entity Type:Organization
Organization Name:ANWAR VARDAG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-488-8368
Mailing Address - Street 1:6156 NW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3374
Mailing Address - Country:US
Mailing Address - Phone:888-382-5603
Mailing Address - Fax:727-523-8093
Practice Address - Street 1:21644 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1842
Practice Address - Country:US
Practice Address - Phone:561-488-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANWAR M VARDAG MM PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-12
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME617922080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15151OtherBC BS ID NUMBER
FL370444100Medicaid