Provider Demographics
NPI:1295205953
Name:MARABANIAN, TODD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:MARABANIAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 BELFORT PKWY APT 122
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6987
Mailing Address - Country:US
Mailing Address - Phone:248-635-3182
Mailing Address - Fax:
Practice Address - Street 1:7750 BELFORT PKWY APT 122
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6987
Practice Address - Country:US
Practice Address - Phone:248-635-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant