Provider Demographics
NPI:1770566143
Name:DOVAL, MARIANA (MD)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:DOVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2030 W MCNAB RD
Mailing Address - Street 2:# 2
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1002
Mailing Address - Country:US
Mailing Address - Phone:561-633-1000
Mailing Address - Fax:561-633-1024
Practice Address - Street 1:10101 FOREST HILL BLVD
Practice Address - Street 2:PATHOLOGY DEPT.
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6103
Practice Address - Country:US
Practice Address - Phone:561-798-8559
Practice Address - Fax:561-798-8645
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME72281207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254170000Medicaid
P00380841OtherRAILROAD MEDICARE
G74682Medicare UPIN
P00380841OtherRAILROAD MEDICARE