MEDICARE: DR. DANIEL MARANCENBAUM MD

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
1	207V00000X	Obstetrics & Gynecology Physician	ME152170	FL
2	207V00000X	Obstetrics & Gynecology Physician	042.0012038	VT
3	207V00000X	Obstetrics & Gynecology Physician	MT189844	PA
4	207V00000X	Obstetrics & Gynecology Physician	MD2013-0460	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790937068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL MARANCENBAUM MD

Provider Business Mailing Address
First Line	:	2055 WALSBROOK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-2436
Country	:	US
Telephone Number	:	505-695-0541
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 WEST RD STE 250
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-5302
Country	:	US
Telephone Number	:	505-661-9201
Fax Number	:	505-661-9185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2008
Last Update Date	:	10/06/2022

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