Provider Demographics
NPI:1851776868
Name:METCARE OF DELAND
Entity Type:Organization
Organization Name:METCARE OF DELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-500-2000
Mailing Address - Street 1:6101 BLUE LAGOON DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2055
Mailing Address - Country:US
Mailing Address - Phone:305-500-2114
Mailing Address - Fax:305-370-6024
Practice Address - Street 1:929 N SPRING GARDEN AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0900
Practice Address - Country:US
Practice Address - Phone:561-805-8530
Practice Address - Fax:502-508-4773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITAN HEALTH NETWORKS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-21
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCX415BOtherMEDICARE PTAN