Healthcare Provider Details

I. General information

NPI: 1831205434
Provider Name (Legal Business Name): MARC EDWARD AGRONIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 NE 2ND AVE
MIAMI FL
33137-2706
US

IV. Provider business mailing address

13342 LAKEPOINTE CIR
COOPER CITY FL
33330-2624
US

V. Phone/Fax

Practice location:
  • Phone: 305-751-8626
  • Fax: 305-762-1439
Mailing address:
  • Phone: 954-880-0083
  • Fax: 954-880-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME77672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: