Organization
FARMVILLE INTERNAL MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICARDO ENRIQUE MARANA MD (PRESIDENT)
(252) 753-3193
Entity
Organization
Contact information
Practice address
3485 N MAIN ST, FARMVILLE, NC 27828-1466
(252) 753-3193
(252) 753-7966
Mailing address
3485 N MAIN ST, FARMVILLE, NC 27828-1466
(252) 753-3193
(252) 753-7966
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20000090
NC
261QP2300X
Primary Care Clinic/Center
200000090
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126A3
BLUE CROSS BLUE SHIELD
NC
05
—
89126A3
—
NC
01
—
DF6187
RAILROAD MEDICARE (GROUP NUMBER)
NC
01
—
P00379704
RAILROAD MEDICARE (PIN)
NC
Enumeration date
04/20/2006
Last updated
04/20/2009
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