MEDICARE: GREGORY MCFADDEN MDPA

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1992989479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY MCFADDEN MDPA

Provider Business Mailing Address
First Line	:	4308 ELLENVILLE PL
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33596-7147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 W SAINT ISABEL ST
Second Line	:	#A-3
City	:	TAMPA
State	:	FL
Zip	:	33607-6371
Country	:	US
Telephone Number	:	813-874-2642
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY L MCFADDEN
Credential	:	MD
Telephone Number	:	813-767-6322

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	01/21/2008

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