Provider Demographics
NPI:1184789893
Name:MARCARIAN, BERGE (MD)
Entity type:Individual
Prefix:DR
First Name:BERGE
Middle Name:
Last Name:MARCARIAN
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: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
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71870207Y00000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32922AMedicare ID - Type Unspecified
FLG43814Medicare UPIN