Provider Demographics
NPI:1013110790
Name:MARGATE PEDIATRICS PA
Entity Type:Organization
Organization Name:MARGATE PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-975-4611
Mailing Address - Street 1:5100 WEST COPANS ROAD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063
Mailing Address - Country:US
Mailing Address - Phone:954-975-4611
Mailing Address - Fax:954-975-4079
Practice Address - Street 1:5100 WEST COPANS ROAD
Practice Address - Street 2:SUITE 800
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-975-4611
Practice Address - Fax:954-975-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83289174400000X
ME83289208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1417947854OtherPERSONAL NPI #
FL265466100Medicaid
FLME83289OtherSTATE MEDICAL LICENSE