Healthcare Provider Details

I. General information

NPI: 1356322572
Provider Name (Legal Business Name): IRENE B MEDARY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 STONEROCK CIR
ORLANDO FL
32819
US

IV. Provider business mailing address

PO BOX 692409
ORLANDO FL
32869-2409
US

V. Phone/Fax

Practice location:
  • Phone: 407-355-0575
  • Fax: 407-355-0576
Mailing address:
  • Phone: 407-355-0575
  • Fax: 407-355-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberME58900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: