MEDICARE: GARDY D. MARCELIN, M.D. PA

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	261QM2500X	Medical Specialty Clinic/Center	ME76514	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790985422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDY D. MARCELIN, M.D. PA

Provider Business Mailing Address
First Line	:	3717 W BOYNTON BEACH BLVD STE 5
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4540
Country	:	US
Telephone Number	:	561-734-1212
Fax Number	:	561-734-1443

Provider Business Practice Location Address
First Line	:	3717 W BOYNTON BEACH BLVD STE 5
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4540
Country	:	US
Telephone Number	:	561-734-1212
Fax Number	:	561-734-1443

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARDY D. MARCELIN
Credential	:	M.D.
Telephone Number	:	561-734-1212

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/05/2012

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