Provider Demographics
NPI:1043262041
Name:NAING, MYO (MD)
Entity type:Individual
Prefix:
First Name:MYO
Middle Name:
Last Name:NAING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 POSEIDON WAY
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-1838
Mailing Address - Country:US
Mailing Address - Phone:207-263-5788
Mailing Address - Fax:
Practice Address - Street 1:3320 POSEIDON WAY
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-1838
Practice Address - Country:US
Practice Address - Phone:207-263-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016903207R00000X
ORMD126158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD126158OtherSTATE LICENSE
OR500609066Medicaid
ME431973699Medicaid
MEME1719Medicare ID - Type Unspecified
OR500609066Medicaid
ORMD126158OtherSTATE LICENSE