Provider Demographics
NPI:1629144498
Name:BINETTE, MARJORIE (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:BINETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 HARTWOOD MARSH RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5390
Mailing Address - Country:US
Mailing Address - Phone:352-394-4237
Mailing Address - Fax:352-394-6097
Practice Address - Street 1:2105 HARTWOOD MARSH RD STE 7
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5390
Practice Address - Country:US
Practice Address - Phone:352-394-4237
Practice Address - Fax:352-394-6097
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07148400207Q00000X
FLME96723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8659508Medicaid
051729Medicare PIN
NJ8659508Medicaid