Healthcare Provider Details

I. General information

NPI: 1497743991
Provider Name (Legal Business Name): LARRY M MARCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAIN ST
NORWAY ME
04268-5645
US

IV. Provider business mailing address

193 MAIN ST
NORWAY ME
04268-5645
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-2835
  • Fax:
Mailing address:
  • Phone:
  • Fax: 207-743-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number029258
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD24353
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: