| Alan Medina, Md Pa | |
|
19 New Water Oak Dr Palm Coast FL 32137-6958 | |
| (917) 856-6519 | |
| (386) 597-2948 |
| Full Name | Alan Medina, Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 19 New Water Oak Dr, Palm Coast, Florida |
| Authorized Official Name and Position | Alan Medina (PRESIDENT) |
| Authorized Official Contact | 9178566519 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alan Medina, Md Pa 19 New Water Oak Dr Palm Coast FL 32137-6958 Ph: (917) 856-6519 | Alan Medina, Md Pa 19 New Water Oak Dr Palm Coast FL 32137-6958 Ph: (917) 856-6519 |
| NPI Number | 1548545809 |
|---|---|
| Provider Enumeration Date | 10/19/2011 |
| Last Update Date | 08/14/2021 |
| Certification Date | 08/14/2021 |
| Medicare PECOS PAC ID | 9931372794 |
|---|---|
| Medicare Enrollment ID | O20210108001426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548545809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 261QM2500X | Clinic/center - Medical Specialty | 170738 (New York) | Secondary |
| Provider Name | Alan Medina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598841439 PECOS PAC ID: 9133222821 Enrollment ID: I20210108001584 |
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