Provider Demographics
NPI:1588730113
Name:MARQUES, VASCO MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:VASCO
Middle Name:MIGUEL
Last Name:MARQUES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 E 138TH AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3904
Mailing Address - Country:US
Mailing Address - Phone:813-975-2800
Mailing Address - Fax:
Practice Address - Street 1:3010 E 138TH AVE
Practice Address - Street 2:SUITE #12
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3904
Practice Address - Country:US
Practice Address - Phone:813-975-2800
Practice Address - Fax:813-977-7631
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80196207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258957500Medicaid
FL258957500Medicaid
FL49997W - TPAMedicare PIN
FL49997V - PASCOMedicare PIN