Healthcare Provider Details

I. General information

NPI: 1407897770
Provider Name (Legal Business Name): MARC G DUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST STE 601 PHYSICIANS PAVILION EAST
BALTIMORE MD
21204-5801
US

IV. Provider business mailing address

6565 N CHARLES ST STE 601 PHYSICIANS PAVILION EAST
BALTIMORE MD
21204-5801
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-5151
  • Fax:
Mailing address:
  • Phone: 410-821-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD62319
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: