MEDICARE: MD 365 MEDICAL CARE PLLC

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1841531142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD 365 MEDICAL CARE PLLC

Provider Business Mailing Address
First Line	:	800-18 MONTAUK HIGHWAY
Second Line	:
City	:	SHIRLEY
State	:	NY
Zip	:	11967-2128
Country	:	US
Telephone Number	:	631-772-4646
Fax Number	:	631-772-2495

Provider Business Practice Location Address
First Line	:	800 MONTAUK HWY STE 18
Second Line	:
City	:	SHIRLEY
State	:	NY
Zip	:	11967-2128
Country	:	US
Telephone Number	:	631-772-4646
Fax Number	:	631-772-2495

Authorized Official
Title or Position	:	M.D
Name	:	DR. DEEPU ALEXANDER
Credential	:	MD
Telephone Number	:	631-772-4646

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	12/06/2019

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