Healthcare Provider Details

I. General information

NPI: 1316945256
Provider Name (Legal Business Name): MARC MORRIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SALEM AVE
CARBONDALE PA
18407-1928
US

IV. Provider business mailing address

49 SALEM AVE
CARBONDALE PA
18407-1928
US

V. Phone/Fax

Practice location:
  • Phone: 570-282-2040
  • Fax: 570-282-2040
Mailing address:
  • Phone: 570-282-2040
  • Fax: 570-282-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC001702L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: