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1053312884

NPI Code Detail

MEDICARE: JEREMIAH RICHARD MARION III MD

MEDICARE: JEREMIAH RICHARD MARION III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	20493	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5612887675	OTHER	NC	CIGNA
2	19473	OTHER	NC	OPTICARE
3	346159	OTHER	NC	MAMSI
4	0852212	OTHER	NC	UNITED HEALTHCARE
5	52628	OTHER	NC	MEDCOST
6	4540374	OTHER	NC	AETNA
7	53935	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1053312884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH RICHARD MARION III MD

Provider Business Mailing Address
First Line	:	4102 N ROXBORO RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704
Country	:	US
Telephone Number	:	919-595-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4102 N ROXBORO ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2122
Country	:	US
Telephone Number	:	919-595-2106
Fax Number	:	919-595-2190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	12/04/2007

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Directions to “ JEREMIAH RICHARD MARION III MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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