Provider Demographics
NPI:1851456560
Name:BERGE MARCARIAN, M.D., P.A.
Entity Type:Organization
Organization Name:BERGE MARCARIAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-719-9993
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32056-1359
Mailing Address - Country:US
Mailing Address - Phone:386-719-9993
Mailing Address - Fax:386-719-4744
Practice Address - Street 1:4551 W US HIGHWAY 90
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4879
Practice Address - Country:US
Practice Address - Phone:386-719-9993
Practice Address - Fax:386-719-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71870207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG43814Medicare UPIN
FL32922AMedicare ID - Type Unspecified