Healthcare Provider Details

I. General information

NPI: 1518285030
Provider Name (Legal Business Name): GARY L GOLDFADEN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 HOLLYWOOD BLVD SUITE 205
HOLLYWOOD FL
33021-6750
US

IV. Provider business mailing address

3816 HOLLYWOOD BLVD SUITE 205
HOLLYWOOD FL
33021-6750
US

V. Phone/Fax

Practice location:
  • Phone: 954-966-5409
  • Fax: 954-966-0852
Mailing address:
  • Phone: 954-966-5409
  • Fax: 954-966-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY L GOLDFADEN
Title or Position: PRESIDENT
Credential: MD
Phone: 954-966-5409