MEDICARE: MICHAEL ANTHONY DEVITA 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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	MD042029E	PA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	163396-0	NY
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	049363	CT
4	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	163396-0	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588636005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANTHONY DEVITA MD

Provider Business Mailing Address
First Line	:	506 LENOX AVE
Second Line	:	ROOM 14-106
City	:	NEW YORK
State	:	NY
Zip	:	10037-1802
Country	:	US
Telephone Number	:	212-939-4693
Fax Number	:	212-939-2263

Provider Business Practice Location Address
First Line	:	506 LENOX AVE
Second Line	:	ROOM 14-106
City	:	NEW YORK
State	:	NY
Zip	:	10037-1802
Country	:	US
Telephone Number	:	212-939-4693
Fax Number	:	212-939-2263

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	12/09/2014

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