MEDICARE: TIFFANY MARUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		NC

General Provider Information

NPI Number	:	1548466204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MARUM M.D.

Provider Business Mailing Address
First Line	:	7 THACKERY PL
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-5023
Country	:	US
Telephone Number	:	919-403-3521
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 SHANNON RD
Second Line	:	SUITE 105
City	:	DURHAM
State	:	NC
Zip	:	27707-6329
Country	:	US
Telephone Number	:	919-419-0242
Fax Number	:	919-401-4172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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