MEDICARE: PDP MD, LLC

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	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1891522470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PDP MD, LLC

Provider Business Mailing Address
First Line	:	101 WORLD DR STE 200
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-6980
Country	:	US
Telephone Number	:	888-776-5958
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 NW 51ST PL STE 3500
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3140
Country	:	US
Telephone Number	:	888-776-5958
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	BENJAMIN FAINO
Credential	:
Telephone Number	:	908-514-6619

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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