MEDICARE: DR. NASIRDIN MADHANY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME34410	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62026	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1316991516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NASIRDIN MADHANY MD

Provider Business Mailing Address
First Line	:	631 PALM SPRINGS DR
Second Line	:	SUITE 101
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-7854
Country	:	US
Telephone Number	:	407-331-1121
Fax Number	:	407-331-1156

Provider Business Practice Location Address
First Line	:	631 PALM SPRINGS DR
Second Line	:	SUITE 101
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-7854
Country	:	US
Telephone Number	:	407-331-1121
Fax Number	:	407-331-1156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. NASIRDIN MADHANY MD” Practice Location

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