Healthcare Provider Details

I. General information

NPI: 1699717611
Provider Name (Legal Business Name): MARK NAGRANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
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:
Mailing address:
  • Phone: 386-423-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: