Provider Demographics
NPI:1003818378
Name:MARASCO, CAROLYN LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:LOUISE
Last Name:MARASCO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:10330 N DALE MABRY HWY STE 190
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4404
Mailing Address - Country:US
Mailing Address - Phone:813-963-7788
Mailing Address - Fax:813-443-8149
Practice Address - Street 1:10330 N DALE MABRY HWY
Practice Address - Street 2:STE 190
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4404
Practice Address - Country:US
Practice Address - Phone:813-963-7788
Practice Address - Fax:813-443-8149
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME76471208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260414100Medicaid