Provider Demographics
NPI:1215185376
Name:DONALD C. MARCUS DO, P.A.
Entity Type:Organization
Organization Name:DONALD C. MARCUS DO, P.A.
Other - Org Name:SUNRISE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CAREY
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-584-6930
Mailing Address - Street 1:6766 W SUNRISE BLVD
Mailing Address - Street 2:101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6072
Mailing Address - Country:US
Mailing Address - Phone:954-584-6930
Mailing Address - Fax:954-584-0025
Practice Address - Street 1:17101 NE 19TH AVE
Practice Address - Street 2:202
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3159
Practice Address - Country:US
Practice Address - Phone:305-944-8638
Practice Address - Fax:305-944-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003857208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374120602Medicaid