Provider Demographics
NPI:1790937068
Name:MARANCENBAUM, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:MARANCENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 WALSBROOK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2436
Mailing Address - Country:US
Mailing Address - Phone:505-695-0541
Mailing Address - Fax:
Practice Address - Street 1:3917 WEST RD STE 250
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-5302
Practice Address - Country:US
Practice Address - Phone:505-661-9201
Practice Address - Fax:505-661-9185
Is Sole Proprietor?:No
Enumeration Date:2008-10-18
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152170207V00000X
VT042.0012038207V00000X
PAMT189844207V00000X
NMMD2013-0460207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM80983294Medicaid