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NPI Code Detail

MEDICARE: WERTHER R. MARCIALES M.D.

MEDICARE: WERTHER R. MARCIALES M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist PhysicianME70054FL
2207R00000XInternal Medicine PhysicianME70054FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
232220OTHERFLBLUE CROSS BLUE SHIELD FL
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619974839
Entity Type Code : Individual
Provider Name (Legal Business Name) : WERTHER R. MARCIALES M.D.
Provider Business Mailing Address
First Line : PO BOX 25487
Second Line :
City : SARASOTA
State : FL
Zip : 34277-2487
Country : US
Telephone Number : 941-202-5342
Fax Number : 855-253-4836
Provider Business Practice Location Address
First Line : 4401 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34210-3142
Country : US
Telephone Number : 941-423-1067
Fax Number : 941-792-7152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 03/20/2023

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