Theresa Fortaleza-Dawson MD PA

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

ME81298 Issued in FL

Legal business name

THERESA FORTALEZA-DAWSON MD PA

Doing business as

Internal Medicine & Geriatric Health

Practice address

2006 NE 49TH St
Ft Lauderdale, FL 33308-4524

Phone

(954) 938-8998

Fax

(954) 938-8984

NPI assigned

Jun 26, 2007

Last updated

Jan 24, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Theresa Fortaleza-Dawson, M.D.NPI 1871507780

Title

Owner

Phone

(954) 938-8998

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Internal Medicine & Geriatric Health Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theresa Redoble Fortaleza-Dawson, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Fort Lauderdale, FL
  • NPI 1871507780
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1144426040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6278 N FEDERAL HWY",
            "address_2": "SUITE 183",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333081916",
            "telephone_number": "954-938-8998",
            "fax_number": "954-938-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 NE 49TH ST",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333084524",
            "telephone_number": "954-938-8998",
            "fax_number": "954-938-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESA FORTALEZA-DAWSON MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "FORTALEZA-DAWSON",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-938-8998",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "ME81298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "03018",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "280599",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH",
            "identifier": "50293",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268019000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Internal Medicine & Geriatric Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Geriatric Medicine (Internal Medicine) Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Geriatric Medicine (Internal Medicine) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.