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General NPI Number Information
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NPI Number | 1659549624
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Entity Type | Organization
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Legal Business Name | LARRY M MARCUS, MD, FACS
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 255 N MAIN ST
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City | BRISTOL
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State | CT
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Zip | 06010-4972
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Country | US
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Telephone | 860-585-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 255 N MAIN ST
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City | BRISTOL
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State | CT
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Zip | 06010-4972
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LARRY MARCUS
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Credential | MD
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Telephone | 860-585-5888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 029258
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License Number State | CT
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