Provider Demographics
NPI:1396852851
Name:JAVITT, MARCIA C
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:C
Last Name:JAVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 S TREASURE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4125
Mailing Address - Country:US
Mailing Address - Phone:301-452-2740
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 14TH ST STE 511
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2116
Practice Address - Country:US
Practice Address - Phone:305-243-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD178812085R0202X
FLME1631952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology