Healthcare Provider Details

I. General information

NPI: 1780758771
Provider Name (Legal Business Name): MAGED DOSS FARID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S WICKHAM RD
WEST MELBOURNE FL
32904-1134
US

IV. Provider business mailing address

250 S WICKHAM RD
WEST MELBOURNE FL
32904-1134
US

V. Phone/Fax

Practice location:
  • Phone: 321-752-5210
  • Fax: 321-752-5388
Mailing address:
  • Phone: 321-752-5210
  • Fax: 321-752-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME81059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: