MEDICARE: MED-CARE MD PA

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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	ME0071493	FL

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

General Provider Information

NPI Number	:	1750536215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-CARE MD PA

Provider Business Mailing Address
First Line	:	13105 CRICKET COVE RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-8405
Country	:	US
Telephone Number	:	904-880-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3661 CROWN POINT CT
Second Line	:	STE A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5967
Country	:	US
Telephone Number	:	904-880-5220
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANANTHY NALLAPILLAI
Credential	:	MD
Telephone Number	:	904-880-5220

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	02/08/2010

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