Provider Demographics
NPI:1679748461
Name:MEDICAL CONCEPTS GROUP PA
Entity Type:Organization
Organization Name:MEDICAL CONCEPTS GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DADURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-655-6325
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 9000
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-655-6325
Mailing Address - Fax:561-366-1198
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 9000
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-655-6325
Practice Address - Fax:561-366-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG64947Medicare UPIN