MEDICARE: DR. MARK GEORGE AGRESTI 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	2084P0800X	Psychiatry Physician	ME60460	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	:	1922167394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK GEORGE AGRESTI M.D.

Provider Business Mailing Address
First Line	:	2010 CONTINENTAL DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3236
Country	:	US
Telephone Number	:	561-842-9550
Fax Number	:	561-842-9114

Provider Business Practice Location Address
First Line	:	2010 CONTINENTAL DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3236
Country	:	US
Telephone Number	:	561-842-9550
Fax Number	:	561-842-9114

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	12/28/2011

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