MEDICARE: MARIAN DAVID 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	174400000X	Specialist	211683	NY
2	207RC0000X	Cardiovascular Disease Physician	211683	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619073046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN DAVID MD

Provider Business Mailing Address
First Line	:	12510 QUEENS BLVD
Second Line	:	SUITE 2701
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1519
Country	:	US
Telephone Number	:	718-261-0444
Fax Number	:	718-261-0940

Provider Business Practice Location Address
First Line	:	12510 QUEENS BLVD
Second Line	:	SUITE 2701
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1519
Country	:	US
Telephone Number	:	718-261-0444
Fax Number	:	718-261-0940

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	10/24/2022

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