Provider Demographics
NPI:1225369630
Name:MARNOCHA, JOHN RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:MARNOCHA
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 1:3330 CROSSINGS CT
Mailing Address - Street 2:PH2
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-2686
Mailing Address - Country:US
Mailing Address - Phone:239-948-9446
Mailing Address - Fax:239-948-9446
Practice Address - Street 1:3330 CROSSINGS CT
Practice Address - Street 2:PH2
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-2686
Practice Address - Country:US
Practice Address - Phone:239-948-9446
Practice Address - Fax:239-948-9446
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14116-20207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology