Provider Demographics
NPI:1568638005
Name:MARC A GRINBERG MD PA
Entity Type:Organization
Organization Name:MARC A GRINBERG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-366-7611
Mailing Address - Street 1:1880 ARLINGTON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3524
Mailing Address - Country:US
Mailing Address - Phone:941-366-7611
Mailing Address - Fax:941-957-4761
Practice Address - Street 1:1880 ARLINGTON ST
Practice Address - Street 2:STE 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3524
Practice Address - Country:US
Practice Address - Phone:941-366-7611
Practice Address - Fax:941-957-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17033332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0494300001Medicare NSC