Provider Demographics
NPI:1891781183
Name:MARC S CARP PL
Entity Type:Organization
Organization Name:MARC S CARP PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-949-2020
Mailing Address - Street 1:PO BOX 848593
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8593
Mailing Address - Country:US
Mailing Address - Phone:305-468-4180
Mailing Address - Fax:305-595-1013
Practice Address - Street 1:1400 NE MIAMI GARDENS DR
Practice Address - Street 2:STE 221
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4844
Practice Address - Country:US
Practice Address - Phone:305-949-2020
Practice Address - Fax:305-949-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0038332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2499150OtherGHI
FLP00120815OtherRAILROAD MEDICARE
FL22472OtherWELLCARE/STAYWELL
FL049699500Medicaid
FL3450134OtherAETNA
FL95735OtherBLUECROSS BLUESHIELD
FLD63588Medicare UPIN
FL3450134OtherAETNA