Basic Information
| Provider Information | |||||||||
| NPI: | 1083774665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VASCO M MARQUES MD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TAMPA CARDIOVASCULAR ASSOCIATES, PA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 E 138TH AVE | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336133904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139752800 | ||||||||
| FaxNumber: | 8139777631 | ||||||||
| Practice Location | |||||||||
| Address1: | 3010 E 138TH AVE | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336133904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139752800 | ||||||||
| FaxNumber: | 8139777631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 06/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | MARQUES | ||||||||
| AuthorizedOfficialFirstName: | VASCO | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8139752800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 258957500 | 05 | FL | MEDICAID |