Provider Demographics
NPI:1093901241
Name:CONSTANTINE G. MAROUSIS MD PA
Entity Type:Organization
Organization Name:CONSTANTINE G. MAROUSIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MAROUSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-366-1400
Mailing Address - Street 1:1950 ARLINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3507
Mailing Address - Country:US
Mailing Address - Phone:941-366-1400
Mailing Address - Fax:941-366-1913
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3507
Practice Address - Country:US
Practice Address - Phone:941-366-1400
Practice Address - Fax:941-366-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73113207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273462100Medicaid
FL1093901241OtherGROUP NPI
FL1437142668Medicare PIN
FLK7024Medicare PIN
FLG78251Medicare UPIN