Healthcare Provider Details

I. General information

NPI: 1235190356
Provider Name (Legal Business Name): NICHOLAS A MARUNIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12109 COUNTY ROAD 103
OXFORD FL
34484-2951
US

IV. Provider business mailing address

12109 COUNTY ROAD 103
OXFORD FL
34484-2951
US

V. Phone/Fax

Practice location:
  • Phone: 352-430-2947
  • Fax: 352-391-6498
Mailing address:
  • Phone: 352-205-8981
  • Fax: 352-391-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME51265
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: