Provider Demographics
NPI:1437142668
Name:MAROUSIS, CONSTANTINE GREGORY (MD)
Entity Type:Individual
Prefix:MR
First Name:CONSTANTINE
Middle Name:GREGORY
Last Name:MAROUSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1950 ARLINGTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3506
Mailing Address - Country:US
Mailing Address - Phone:941-366-1400
Mailing Address - Fax:941-366-1913
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3506
Practice Address - Country:US
Practice Address - Phone:941-366-1400
Practice Address - Fax:941-366-1913
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73113207RG0100X
GA075446207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43627YMedicare PIN
FLG78251Medicare UPIN
FLK7024Medicare PIN