Healthcare Provider Details

I. General information

NPI: 1679651665
Provider Name (Legal Business Name): JOHN V MARRACCINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 SUNSET DR SUITE 407
SOUTH MIAMI FL
33143-4827
US

IV. Provider business mailing address

6280 SUNSET DR SUITE 407
SOUTH MIAMI FL
33143-4827
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-8858
  • Fax: 305-665-1731
Mailing address:
  • Phone: 305-666-8858
  • Fax: 305-665-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME36275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: