1467472001 NPI number — MR. ADAM LOUIS MARCONI II

Table of content: MR. ADAM LOUIS MARCONI II (NPI 1467472001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467472001 NPI number — MR. ADAM LOUIS MARCONI II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCONI
Provider First Name:
ADAM
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
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:
1467472001
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2153 BOXWOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34289-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-429-2149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 BAHIA VISTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-365-2830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2006

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: 225100000X , with the licence number:  PT6739 , 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: 5144793 . This is a "ATENA NON HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00272541 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 966449 . This is a "PA BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: Y4395 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2192216 . This is a "ATENA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 640076 . This is a "PCA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: S2078 . This is a "PRINCIPLE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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