Provider Demographics
NPI:1053312884
Name:MARION, JEREMIAH RICHARD III (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:RICHARD
Last Name:MARION
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 N ROXBORO RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:919-595-2000
Mailing Address - Fax:
Practice Address - Street 1:4102 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2122
Practice Address - Country:US
Practice Address - Phone:919-595-2106
Practice Address - Fax:919-595-2190
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20493207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5612887675OtherCIGNA
NC19473OtherOPTICARE
NC346159OtherMAMSI
NC0852212OtherUNITED HEALTHCARE
NC52628OtherMEDCOST
NC4540374OtherAETNA
NC53935OtherBCBS NC
C85489Medicare UPIN
NC201884GMedicare ID - Type UnspecifiedCIGNA
NC8953935Medicare ID - Type UnspecifiedEDS FEDERAL