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General NPI Number Information
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NPI Number | 1619258886
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Entity Type | Individual
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Provider Name | MARC EVERETT MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 03/11/2023
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Provider Practice Location Address
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Address Line | 936 5TH AVE # 1
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City | NEW YORK
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State | NY
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Zip | 10021-2653
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Country | US
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Telephone | 212-774-7715
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Fax | 516-900-5022
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Provider Business Mailing Address
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Address Line | 936 5TH AVE # 1
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City | NEW YORK
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State | NY
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Zip | 10021-2653
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Country | US
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Telephone | 212-774-7715
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Fax | 516-900-5022
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD448452
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A117439
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | Q7866
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 287559
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License Number State | NY
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