Provider Demographics
NPI:1770329450
Name:MD ON THE GO PCP LLC
Entity type:Organization
Organization Name:MD ON THE GO PCP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREA BARBOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-895-2091
Mailing Address - Street 1:1401 N UNIVERSITY DR STE 305
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6088
Mailing Address - Country:US
Mailing Address - Phone:561-849-4810
Mailing Address - Fax:
Practice Address - Street 1:1401 N UNIVERSITY DR STE 305
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6088
Practice Address - Country:US
Practice Address - Phone:561-849-4810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty