Provider Demographics
NPI:1144936584
Name:DAVID MEDICAL LLC
Entity type:Organization
Organization Name:DAVID MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-545-6132
Mailing Address - Street 1:1155 WILDMEADOW RUN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3036
Mailing Address - Country:US
Mailing Address - Phone:786-545-6132
Mailing Address - Fax:
Practice Address - Street 1:1155 WILDMEADOW RUN
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3036
Practice Address - Country:US
Practice Address - Phone:786-545-6132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107666700Medicaid