1265592745 NPI number — S S MARATHE MD PA

Table of content: (NPI 1265592745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265592745 NPI number — S S MARATHE MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S S MARATHE MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDICAL SPECIALISTS OF HASTINGS
Provider Other Organization Name Type Code:
3
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:
1265592745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
665 STATE ROAD 207
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SAINT AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32084-5938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-824-8158
Provider Business Mailing Address Fax Number:
904-823-1284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 WEST LATTIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-824-8158
Provider Business Practice Location Address Fax Number:
904-823-1284
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARATHE
Authorized Official First Name:
SHRIRAM
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-824-8158

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  94907 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: 91451 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 250270403 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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