Healthcare Provider Details

I. General information

NPI: 1306101894
Provider Name (Legal Business Name): MARIA DESCHAINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-5018
US

IV. Provider business mailing address

PO BOX 100279
GAINESVILLE FL
32610-0279
US

V. Phone/Fax

Practice location:
  • Phone: 352-594-1942
  • Fax:
Mailing address:
  • Phone: 352-594-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number22525
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29028
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number29028
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME156435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: