Basic Information
| Provider Information | |||||||||
| NPI: | 1972592715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANCO | ||||||||
| FirstName: | MARCELO | ||||||||
| MiddleName: | CASTELLO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 N E ST | ||||||||
| Address2: | STE 331 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325016335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509697979 | ||||||||
| FaxNumber: | 8504769352 | ||||||||
| Practice Location | |||||||||
| Address1: | 8333 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325146050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509697979 | ||||||||
| FaxNumber: | 8504769352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME56014 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | ME56014 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 060065398 | 01 | RAILROAD MEDICARE | OTHER | 2500239 | 01 | UNITED HEALTHCARE | OTHER | 59043189BRA | 01 | AL | BCBS OF ALABAMA | OTHER | 09471 | 01 | FL | BCBS | OTHER | 009962410 | 05 | AL | MEDICAID | 5452027 | 01 | AETNA | OTHER | 061495500 | 05 | FL | MEDICAID |