Provider Demographics
NPI:1255383592
Name:MADWAR, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:MADWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 GULF SHORE BLVD N
Mailing Address - Street 2:SUITE 166
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-4968
Mailing Address - Country:US
Mailing Address - Phone:239-352-5550
Mailing Address - Fax:239-352-5545
Practice Address - Street 1:1400 GULF SHORE BLVD N
Practice Address - Street 2:SUITE 166
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-4968
Practice Address - Country:US
Practice Address - Phone:239-352-5550
Practice Address - Fax:239-352-5545
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLFLME0082289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263724300Medicaid
FLG85103Medicare UPIN
FL263724300Medicaid