1346288669 NPI number — MICHAEL E MARRERO M.D.

Table of content: MICHAEL E MARRERO M.D. (NPI 1346288669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346288669 NPI number — MICHAEL E MARRERO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARRERO
Provider First Name:
MICHAEL
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346288669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1849
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04241-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-784-2554
Provider Business Mailing Address Fax Number:
207-777-5363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 UNIVERSITY SQUARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612-5513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-251-5822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  73844 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME131980 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4276160 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300134039 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292780099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3405042 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3078337 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0109754Y0NH02 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30203233 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119515700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com