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General NPI Number Information
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NPI Number | 1265592745
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Entity Type | Organization
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Legal Business Name | S S MARATHE MD PA
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 201 WEST LATTIN STREET
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City | HASTINGS
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State | FL
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Zip | 32145
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Country | US
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Telephone | 904-824-8158
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Fax | 904-823-1284
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Provider Business Mailing Address
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Address Line | 665 STATE ROAD 207 SUITE 102
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-5938
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Country | US
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Telephone | 904-824-8158
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Fax | 904-823-1284
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHRIRAM S MARATHE
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Credential | MD
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Telephone | 904-824-8158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 91451
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 94907
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License Number State | FL
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