Healthcare Provider Details

I. General information

NPI: 1265466791
Provider Name (Legal Business Name): MARCUS ALI THORNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E VAN TREES ST
WASHINGTON IN
47501-2948
US

IV. Provider business mailing address

PO BOX 760
WASHINGTON IN
47501-0760
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2663
  • Fax:
Mailing address:
  • Phone: 812-254-7310
  • Fax: 812-257-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01060526A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: