Provider Demographics
NPI:1205803657
Name:MARGATE FAMILY MEDICAL CENTER INC
Entity type:Organization
Organization Name:MARGATE FAMILY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VASANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRASEKARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-956-7979
Mailing Address - Street 1:3113 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7006
Mailing Address - Country:US
Mailing Address - Phone:954-956-7979
Mailing Address - Fax:954-956-8681
Practice Address - Street 1:3113 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7006
Practice Address - Country:US
Practice Address - Phone:954-956-7979
Practice Address - Fax:954-956-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G77175Medicare UPIN
FL44328Medicare ID - Type Unspecified