Provider Demographics
NPI:1124216734
Name:MARC J. DILORENZO M.D., P.A.
Entity Type:Organization
Organization Name:MARC J. DILORENZO M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-732-5550
Mailing Address - Street 1:1731 SW 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8179
Mailing Address - Country:US
Mailing Address - Phone:352-732-5550
Mailing Address - Fax:352-369-6687
Practice Address - Street 1:1731 SW 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8179
Practice Address - Country:US
Practice Address - Phone:352-732-5550
Practice Address - Fax:352-369-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1540Medicare PIN
FL42201YMedicare PIN