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General NPI Number Information
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NPI Number | 1235823691
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Entity Type | Organization
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Legal Business Name | PEDIATRIC MEDICAL CENTER LLC
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 836 PAUL STREET
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City | ORLANDO
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State | FL
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Zip | 32808
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Country | US
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Telephone | 407-342-1896
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Fax | 407-369-4279
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Provider Business Mailing Address
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Address Line | 836 PAUL STREET
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City | ORLANDO
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State | FL
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Zip | 32808
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Country | US
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Telephone | 407-342-1896
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Fax | 407-369-4279
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Authorized Official
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Title or Position | PRESIDENT
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Name | GHAZALA AHMED
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Credential | M.D.
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Telephone | 321-947-5901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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