Provider Demographics
NPI:1891243143
Name:ADVANCED MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUNAWARDENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-283-0384
Mailing Address - Street 1:3347 STATE ROAD 7
Mailing Address - Street 2:STE 206
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8095
Mailing Address - Country:US
Mailing Address - Phone:561-434-1935
Mailing Address - Fax:
Practice Address - Street 1:1236 ROYAL PALM BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1602
Practice Address - Country:US
Practice Address - Phone:561-434-1935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty