Provider Demographics
NPI:1891522470
Name:PDP MD, LLC
Entity type:Organization
Organization Name:PDP MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-514-6619
Mailing Address - Street 1:101 WORLD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6980
Mailing Address - Country:US
Mailing Address - Phone:888-776-5958
Mailing Address - Fax:
Practice Address - Street 1:1004 NW 51ST PL STE 3500
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3140
Practice Address - Country:US
Practice Address - Phone:888-776-5958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company