Provider Demographics
NPI:1275530628
Name:MARCANTEL, DAVID ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ASHLEY
Last Name:MARCANTEL
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 1:410 CELEBRATION PL
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5433
Mailing Address - Country:US
Mailing Address - Phone:407-566-2229
Mailing Address - Fax:407-566-2499
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:SUITE 208
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5433
Practice Address - Country:US
Practice Address - Phone:407-566-2229
Practice Address - Fax:407-566-2499
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68062207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378029500Medicaid
FL378029500Medicaid
FL27409CMedicare PIN