Provider Demographics
NPI:1912165184
Name:MARANCENBAUM, ARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ARIE
Middle Name:
Last Name:MARANCENBAUM
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 1:7501 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-9322
Mailing Address - Country:US
Mailing Address - Phone:469-417-8550
Mailing Address - Fax:
Practice Address - Street 1:7501 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9322
Practice Address - Country:US
Practice Address - Phone:972-526-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0633207P00000X, 207Q00000X
WI5496820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284470601Medicaid