Provider Demographics
NPI:1467471235
Name:MARZANO, MARK JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOHN
Last Name:MARZANO
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 1:2338 IMMOKALEE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1445
Mailing Address - Country:US
Mailing Address - Phone:239-430-4674
Mailing Address - Fax:239-430-0055
Practice Address - Street 1:1350 TAMIAMI TRL N
Practice Address - Street 2:STE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5209
Practice Address - Country:US
Practice Address - Phone:239-430-4674
Practice Address - Fax:239-659-6530
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81325261QR0200X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51707OtherBCBS PROVIDER
FL260090100Medicaid
FL51707OtherBCBS PROVIDER
FL260090100Medicaid