Provider Demographics
NPI:1669441374
Name:MARENCO, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MARENCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1270
Mailing Address - Country:US
Mailing Address - Phone:413-781-5735
Mailing Address - Fax:
Practice Address - Street 1:300 STAFFORD ST STE 154
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3583
Practice Address - Country:US
Practice Address - Phone:413-748-7095
Practice Address - Fax:413-733-5604
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157824207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0190471Medicaid
MA0190471Medicaid
MAA31546Medicare PIN
A31546Medicare ID - Type Unspecified