Provider Demographics
NPI:1609862077
Name:PEVSNER, NORMAN HENRY (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:HENRY
Last Name:PEVSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1607
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-1607
Mailing Address - Country:US
Mailing Address - Phone:561-478-0603
Mailing Address - Fax:
Practice Address - Street 1:4515 WILES RD STE 101
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3414
Practice Address - Country:US
Practice Address - Phone:561-478-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME193752085R0202X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD26951Medicare UPIN
FL71834WMedicare PIN
FL71834JMedicare PIN
FL300025570Medicare PIN
FL71834Medicare PIN
FL300025571Medicare PIN
FL300075286Medicare PIN
FL71834SMedicare PIN
FLP00062428Medicare PIN
FL71834HMedicare PIN