Provider Demographics
NPI:1821172396
Name:MARRACHE, RONNIE C (MD)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:C
Last Name:MARRACHE
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 1:4700 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-1316
Mailing Address - Fax:912-350-6335
Practice Address - Street 1:109 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-872-0866
Practice Address - Fax:207-872-8098
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014513207R00000X
GA040730208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132900099Medicaid
ME025781OtherANTHEM
MEMX6596Medicare PIN
G45840Medicare UPIN