Provider Demographics
NPI:1750998654
Name:MARIAN INFECTIOUS DISEASE PLLC
Entity type:Organization
Organization Name:MARIAN INFECTIOUS DISEASE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-756-9337
Mailing Address - Street 1:10174 BELCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-2607
Mailing Address - Country:US
Mailing Address - Phone:646-756-9337
Mailing Address - Fax:
Practice Address - Street 1:10174 BELCREST BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-2607
Practice Address - Country:US
Practice Address - Phone:646-756-9337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty