MEDICARE: MARINA OMAROV PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9107465	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316369234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA OMAROV PA

Provider Business Mailing Address
First Line	:	1945 S OCEAN DR APT 1912
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-6089
Country	:	US
Telephone Number	:	786-252-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 E HALLANDALE BEACH BLVD STE 302
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-3771
Country	:	US
Telephone Number	:	786-252-8258
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2014
Last Update Date	:	04/27/2026

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Directions to “ MARINA OMAROV PA” Practice Location

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