=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790842508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARC N DUBICK MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 11/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 835 DUCK HAWK RETREAT
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-697-1671
-----------------------------------------------------
Fax | 844-406-4501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 835 DUCK HAWK RETREAT
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-697-1671
-----------------------------------------------------
Fax | 844-406-4501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARC N DUBICK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 843-697-1671
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 20700
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------