Healthcare Provider Details

I. General information

NPI: 1922446756
Provider Name (Legal Business Name): MARC BRANCHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W UNDERWOOD ST MP 153
ORLANDO FL
32806
US

IV. Provider business mailing address

52 W UNDERWOOD ST MP 153
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-8475
  • Fax: 407-849-6470
Mailing address:
  • Phone: 321-842-8475
  • Fax: 407-849-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number315913
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA11498000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME183088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: