Provider Demographics
NPI:1154542967
Name:MARCANO-CENTENO, GEOVANNIE (MD)
Entity type:Individual
Prefix:DR
First Name:GEOVANNIE
Middle Name:
Last Name:MARCANO-CENTENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GEOVANNIE
Other - Middle Name:
Other - Last Name:MARCANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1179 NW 166TH AVE
Mailing Address - Street 2:PEMBROKE PINES
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1344
Mailing Address - Country:US
Mailing Address - Phone:754-400-8644
Mailing Address - Fax:
Practice Address - Street 1:1179 NW 166TH AVE
Practice Address - Street 2:PEMBROKE PINES
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1344
Practice Address - Country:US
Practice Address - Phone:754-400-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13887282N00000X
FLME102854207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR02163Medicare UPIN