Provider Demographics
NPI:1336160514
Name:MARIANA MARTINASEVIC MD PA
Entity Type:Organization
Organization Name:MARIANA MARTINASEVIC MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINASEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:954-491-4455
Mailing Address - Street 1:6245 N FEDERAL HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1998
Mailing Address - Country:US
Mailing Address - Phone:954-491-4455
Mailing Address - Fax:954-491-4553
Practice Address - Street 1:6245 N FEDERAL HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1998
Practice Address - Country:US
Practice Address - Phone:954-491-4455
Practice Address - Fax:954-491-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37860IOtherBLUE CROSS BLUE SHIELD
FLK9009Medicare ID - Type UnspecifiedMEDICARE PRV NUMBER