Provider Demographics
NPI:1013108992
Name:S S MARATHE MD PA
Entity type:Organization
Organization Name:S S MARATHE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHRIRAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARATHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-824-8158
Mailing Address - Street 1:665 STATE ROAD 207
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5938
Mailing Address - Country:US
Mailing Address - Phone:904-824-8158
Mailing Address - Fax:
Practice Address - Street 1:4869 PALM COAST PKWY NW
Practice Address - Street 2:SUITE 2
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3661
Practice Address - Country:US
Practice Address - Phone:386-445-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250270401Medicaid
FL97652AMedicare PIN