Provider Demographics
NPI:1750469060
Name:EDGAR A MARIN MD PA
Entity Type:Organization
Organization Name:EDGAR A MARIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-220-0352
Mailing Address - Street 1:1117 SW 150TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2580
Mailing Address - Country:US
Mailing Address - Phone:305-220-0352
Mailing Address - Fax:305-220-0354
Practice Address - Street 1:12813 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3424
Practice Address - Country:US
Practice Address - Phone:305-220-0352
Practice Address - Fax:305-220-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93016261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH97920Medicare UPIN
FLU5370AMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
FLK9513Medicare ID - Type UnspecifiedEDGAR A MARIN MD PA