Provider Demographics
NPI:1477737732
Name:MARAIR INTERNATIONAL INC
Entity type:Organization
Organization Name:MARAIR INTERNATIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FIORENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-654-0054
Mailing Address - Street 1:485 INDIGO LOOP
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-5226
Mailing Address - Country:US
Mailing Address - Phone:850-654-0054
Mailing Address - Fax:
Practice Address - Street 1:4507 FURLING LN
Practice Address - Street 2:SUITE 110
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5328
Practice Address - Country:US
Practice Address - Phone:850-654-0054
Practice Address - Fax:850-654-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99642261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279326100Medicaid
FLAI830Medicare PIN
FL279326100Medicaid