Healthcare Provider Details

I. General information

NPI: 1891522470
Provider Name (Legal Business Name): PDP MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 NW 51ST PL STE 3500
FORT LAUDERDALE FL
33309-3140
US

IV. Provider business mailing address

101 WORLD DR STE 200
PEACHTREE CITY GA
30269-6980
US

V. Phone/Fax

Practice location:
  • Phone: 888-776-5958
  • Fax:
Mailing address:
  • Phone: 888-776-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN FAINO
Title or Position: GENERAL COUNSEL
Credential:
Phone: 908-514-6619