Provider Demographics
NPI:1750536215
Name:MED-CARE MD PA
Entity type:Organization
Organization Name:MED-CARE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLAPILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-880-5220
Mailing Address - Street 1:13105 CRICKET COVE RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-8405
Mailing Address - Country:US
Mailing Address - Phone:904-880-5220
Mailing Address - Fax:
Practice Address - Street 1:3661 CROWN POINT CT
Practice Address - Street 2:STE A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5967
Practice Address - Country:US
Practice Address - Phone:904-880-5220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071493207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG40471Medicare UPIN