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General NPI Number Information
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NPI Number | 1740212364
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Entity Type | Individual
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Provider Name | MARC P JACQUET MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST PAVILLION 1203
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-4618
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Fax | 207-662-6254
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Provider Business Mailing Address
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Address Line | 301 US ROUTE 1 BUILDING C
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7609
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD14727
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD14727
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License Number State | ME
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