Provider Demographics
NPI:1972592715
Name:BRANCO, MARCELO CASTELLO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:CASTELLO
Last Name:BRANCO
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 1:125 BAPTIST WAY STE 3A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2274
Mailing Address - Country:US
Mailing Address - Phone:448-227-6500
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:9400 UNIVERSITY PKWY STE 306
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5485
Practice Address - Country:US
Practice Address - Phone:850-484-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56014207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2500239OtherUNITED HEALTHCARE
AL59043189BRAOtherBCBS OF ALABAMA
060065398OtherRAILROAD MEDICARE
FL09471OtherBCBS
5452027OtherAETNA
AL009962410Medicaid
FL061495500Medicaid
C66045Medicare UPIN
FL09471YMedicare ID - Type Unspecified