Provider Demographics
NPI:1629357793
Name:TRICOUNTY MEDICAL ASSOCIATION,LLC
Entity Type:Organization
Organization Name:TRICOUNTY MEDICAL ASSOCIATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:KHURSHID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-353-3542
Mailing Address - Street 1:5150 MAJESTIC WOODS PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5150 MAJESTIC WOODS PL
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5400
Practice Address - Country:US
Practice Address - Phone:321-352-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty