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General NPI Number Information
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NPI Number | 1699863936
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Entity Type | Organization
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Legal Business Name | BETHESDA HEALTH PHYSICIAN GROUP, INC.
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 2815 S SEACREST BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7969
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Country | US
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Telephone | 561-737-7733
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Fax | 561-733-5912
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Provider Business Mailing Address
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Address Line | 2815 S SEACREST BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7969
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Country | US
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Telephone | 561-737-7733
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Fax | 561-733-5912
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MARCELLA GRAVALESE
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Credential |
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Telephone | 561-955-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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