Healthcare Provider Details

I. General information

NPI: 1780030130
Provider Name (Legal Business Name): SAMANTHA ALEXA MARRONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 07/15/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 W GORE ST STE 200A
ORLANDO FL
32806-1124
US

IV. Provider business mailing address

70 W GORE ST STE 200A
ORLANDO FL
32806-1124
US

V. Phone/Fax

Practice location:
  • Phone: 407-581-2888
  • Fax: 407-481-0073
Mailing address:
  • Phone: 407-581-2888
  • Fax: 407-481-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME137599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: