Healthcare Provider Details

I. General information

NPI: 1467505198
Provider Name (Legal Business Name): YURI MARCHUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 BEISER BLVD #201 A
DOVER DE
19904-7790
US

IV. Provider business mailing address

153 WILLIS RD APT F
DOVER DE
19901-4028
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7246
  • Fax: 302-678-8890
Mailing address:
  • Phone: 302-359-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberC1-0008045
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: