Provider Demographics
NPI:1780056275
Name:MARC S BARASCH DO
Entity type:Organization
Organization Name:MARC S BARASCH DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:BARASCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-302-9622
Mailing Address - Street 1:1751 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5537
Mailing Address - Country:US
Mailing Address - Phone:727-302-9622
Mailing Address - Fax:727-302-9711
Practice Address - Street 1:1751 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5537
Practice Address - Country:US
Practice Address - Phone:727-302-9622
Practice Address - Fax:727-302-9711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01108458OtherAMERIGROUP
197836OtherWELLCARE
5014675OtherAETNA
57402OtherBLUECROSS BLUESHIELD
FL253399500Medicaid
FL253399500Medicaid