Provider Demographics
NPI:1871624239
Name:MARKAN MEDICINE CSP
Entity type:Organization
Organization Name:MARKAN MEDICINE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:MARCANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-878-2570
Mailing Address - Street 1:LUIS GANDIA SANTOS STREET 63
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4035
Mailing Address - Country:US
Mailing Address - Phone:787-878-2570
Mailing Address - Fax:787-878-2570
Practice Address - Street 1:LUIS GANDIA SANTOS STREET 63
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4035
Practice Address - Country:US
Practice Address - Phone:787-878-2570
Practice Address - Fax:787-878-2570
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARCANO LABORATORY&XRAY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRY00998Medicare UPIN