Provider Demographics
NPI:1114996857
Name:DEVARIE, MARCOS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:
Last Name:DEVARIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1630
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1630
Mailing Address - Country:US
Mailing Address - Phone:787-746-7990
Mailing Address - Fax:787-743-1340
Practice Address - Street 1:VENUS STREET ESQ. SOL
Practice Address - Street 2:SUITE # 2
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-7990
Practice Address - Fax:787-743-1340
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5544207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-83327Medicare UPIN
PR2-6738Medicare ID - Type Unspecified