# MARCELLO A BORZATTA MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609090158
- **Authorized official:** MARCELLO A BORZATTA MD (PRESIDENT)
- **Authorized official phone:** (850) 849-1642

## Contact information

- **Practice address:** 435 BROOKMEADE DR, CRESTVIEW, FL 32539-7304
- **Practice address phone:** (850) 305-2105
- **Practice address fax:** (239) 663-3061
- **Mailing address:** 2260 S FERDON BLVD, CRESTVIEW, FL 32536-8457
- **Mailing address phone:** (850) 305-2105
- **Mailing address fax:** (239) 663-3061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/13/2007
- **Last updated:** 05/24/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 277995100 | — | FL |
| 01 | — | 93788 | BCBS | — |