Provider Demographics
NPI:1487846382
Name:S S MARATHE MD PA
Entity Type:Organization
Organization Name:S S MARATHE MD PA
Other - Org Name:MEDICAL SPECIALISTS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHRIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARATHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-824-8158
Mailing Address - Street 1:665 STATE ROAD 207
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5938
Mailing Address - Country:US
Mailing Address - Phone:904-824-8158
Mailing Address - Fax:
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:SUITE 510
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3883
Practice Address - Country:US
Practice Address - Phone:386-325-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250270402Medicaid
FL250270402Medicaid