MEDICARE: BERGE MARCARIAN, M.D., P.A.

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	207Y00000X	Otolaryngology Physician	ME71870	FL

General Provider Information

NPI Number	:	1851456560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGE MARCARIAN, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1359
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-1359
Country	:	US
Telephone Number	:	386-719-9993
Fax Number	:	386-719-4744

Provider Business Practice Location Address
First Line	:	4551 W US HIGHWAY 90
Second Line	:	SUITE 101
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4879
Country	:	US
Telephone Number	:	386-719-9993
Fax Number	:	386-719-4744

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BERGE MARCARIAN
Credential	:	M.D.
Telephone Number	:	386-719-9993

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	08/22/2020

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