Healthcare Provider Details

I. General information

NPI: 1699863936
Provider Name (Legal Business Name): BETHESDA HEALTH PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SEACREST BLVD
BOYNTON BEACH FL
33435-7969
US

IV. Provider business mailing address

2815 S SEACREST BLVD
BOYNTON BEACH FL
33435-7969
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-7733
  • Fax: 561-733-5912
Mailing address:
  • Phone: 561-737-7733
  • Fax: 561-733-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCELLA GRAVALESE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 561-955-5155