MEDICARE: DR. PETER MARLIN 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	2084P0800X	Psychiatry Physician	12873	HI
2	2084P0800X	Psychiatry Physician	DR.0066406	CO

General Provider Information

NPI Number	:	1982694683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER MARLIN MD

Provider Business Mailing Address
First Line	:	2860 S CIRCLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4113
Country	:	US
Telephone Number	:	719-922-1882
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 S CIRCLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4113
Country	:	US
Telephone Number	:	719-540-2146
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	02/08/2022

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