Healthcare Provider Details

I. General information

NPI: 1659751642
Provider Name (Legal Business Name): MATTHEW JOSEPH MARR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TURNPIKE STREET SUITE 202 JEFFERSON OFFICE PARK
NORTH ANDOVER MA
01845
US

IV. Provider business mailing address

800 TURNPIKE STREET SUITE 202 JEFFERSON OFFICE PARK
NORTH ANDOVER MA
01845
US

V. Phone/Fax

Practice location:
  • Phone: 978-557-5712
  • Fax: 978-557-5406
Mailing address:
  • Phone: 978-557-5712
  • Fax: 978-557-5406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT208004
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: