Provider Demographics
NPI:1558786988
Name:IAN C. MARRERO-AMADEO MD, LLC
Entity Type:Organization
Organization Name:IAN C. MARRERO-AMADEO MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MARRERO-AMADEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-920-4664
Mailing Address - Street 1:310 AVE LOMAS VERDES
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6638
Mailing Address - Country:US
Mailing Address - Phone:787-272-5000
Mailing Address - Fax:
Practice Address - Street 1:310 AVE LOMAS VERDES
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-6638
Practice Address - Country:US
Practice Address - Phone:787-272-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR144872082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREO568AMedicare UPIN