Healthcare Provider Details

I. General information

NPI: 1730485897
Provider Name (Legal Business Name): MDPREVENT MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD H-1
DELRAY BEACH FL
33484-6596
US

IV. Provider business mailing address

5130 LINTON BLVD H-1
DELRAY BEACH FL
33484-6596
US

V. Phone/Fax

Practice location:
  • Phone: 561-807-2561
  • Fax: 561-537-8221
Mailing address:
  • Phone: 561-807-2561
  • Fax: 561-537-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME89947
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN S CHARLAP
Title or Position: CHIEF SERVICE OFFICER
Credential: MD
Phone: 617-319-6434