Provider Demographics
NPI:1790031300
Name:INTERACTIVEMD LLC
Entity Type:Organization
Organization Name:INTERACTIVEMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:888-657-2560
Mailing Address - Street 1:5300 BROKEN SOUND BLVD NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3520
Mailing Address - Country:US
Mailing Address - Phone:888-657-2560
Mailing Address - Fax:561-998-2057
Practice Address - Street 1:5300 BROKEN SOUND BLVD NW
Practice Address - Street 2:SUITE 200
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3520
Practice Address - Country:US
Practice Address - Phone:888-657-2560
Practice Address - Fax:561-998-2057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONCALL ONLINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty