Healthcare Provider Details

I. General information

NPI: 1326008731
Provider Name (Legal Business Name): RONALD ALLEN MARVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 TURNPIKE ST
N ANDOVER MA
01845-5924
US

IV. Provider business mailing address

575 TURNPIKE ST
N ANDOVER MA
01845-5924
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-1946
  • Fax: 978-975-3925
Mailing address:
  • Phone: 978-794-1946
  • Fax: 978-975-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number44044
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: