Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD24353 | ME |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 029258 | CT |
NPI | 1497743991 |
---|---|
Provider Name | Dr. Larry M Marcus |
First Address | Norway, ME 04268-5645 |
Second Address | Norway, ME 04268-5645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B39282 | (02) | CT |