MEDICARE: DR. MERVAT R. MAKRAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	157381	NY

General Provider Information

NPI Number	:	1336388313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERVAT R. MAKRAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:
City	:	WOODBOURNE
State	:	NY
Zip	:	12788-1000
Country	:	US
Telephone Number	:	845-434-7730
Fax Number	:	845-434-7730

Provider Business Practice Location Address
First Line	:	99 PRISON RD
Second Line	:
City	:	WOODBOURNE
State	:	NY
Zip	:	12788-1000
Country	:	US
Telephone Number	:	845-434-7730
Fax Number	:	845-434-7730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	02/13/2009

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