Healthcare Provider Details

I. General information

NPI: 1780889758
Provider Name (Legal Business Name): MARC ROBERT POLECRITTI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10429 SPRING HILL DR
SPRING HILL FL
34608-5043
US

IV. Provider business mailing address

10429 SPRING HILL DR
SPRING HILL FL
34608-5043
US

V. Phone/Fax

Practice location:
  • Phone: 352-556-5248
  • Fax: 352-556-5249
Mailing address:
  • Phone: 352-556-5248
  • Fax: 352-556-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberOS10930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: