Healthcare Provider Details

I. General information

NPI: 1063406288
Provider Name (Legal Business Name): MARION MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 SW 2ND AVE
OCALA FL
34474-4226
US

IV. Provider business mailing address

1623 SW 1ST AVE
OCALA FL
34474-4028
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-3005
  • Fax: 352-732-9828
Mailing address:
  • Phone: 352-732-9844
  • Fax: 352-732-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RAM VASUDEVAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-732-9844