Provider Demographics
NPI:1831205434
Name:AGRONIN, MARC EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:EDWARD
Last Name:AGRONIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13342 LAKEPOINTE CIR
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2624
Mailing Address - Country:US
Mailing Address - Phone:954-880-0083
Mailing Address - Fax:954-880-0084
Practice Address - Street 1:5200 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2706
Practice Address - Country:US
Practice Address - Phone:305-751-8626
Practice Address - Fax:305-762-1439
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME776722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001064000Medicaid
FLE2611ZMedicare ID - Type Unspecified
FL001064000Medicaid