Healthcare Provider Details

I. General information

NPI: 1598438962
Provider Name (Legal Business Name): PEDIATRIX MEDICAL GROUP FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W ATLANTIC BLVD
POMPANO BEACH FL
33060-5916
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-5418
  • Fax: 855-527-5510
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-527-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS E. GLASER
Title or Position: PRESIDENT
Credential:
Phone: 800-243-3839