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General NPI Number Information
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NPI Number | 1992705826
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Entity Type | Individual
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Provider Name | MARC NATHAN DUBICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 835 DUCK HAWK RETREAT
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City | CHARLESTON
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State | SC
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Zip | 29412
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Country | US
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Telephone | 843-697-1671
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Fax | 844-406-4501
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Provider Business Mailing Address
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Address Line | 835 DUCK HAWK RETREAT
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City | CHARLESTON
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State | SC
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Zip | 29412
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Country | US
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Telephone | 843-697-1671
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Fax | 844-406-4501
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | SC20700
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License Number State | SC
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