Healthcare Provider Details

I. General information

NPI: 1326194713
Provider Name (Legal Business Name): MARK A NAGRANI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7327
US

IV. Provider business mailing address

612 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7327
US

V. Phone/Fax

Practice location:
  • Phone: 386-423-5500
  • Fax: 386-409-9762
Mailing address:
  • Phone: 386-423-5500
  • Fax: 386-409-9762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME48245
License Number StateFL

VIII. Authorized Official

Name: DR. MARK NAGRANI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 386-423-5500