Provider Demographics
NPI:1053628610
Name:GARCIA, MARLON GERMAN
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:GERMAN
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3356
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-3356
Mailing Address - Country:US
Mailing Address - Phone:508-816-1698
Mailing Address - Fax:
Practice Address - Street 1:111 EDGARTOWN VINEYARD HAVEN RD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-4036
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:508-696-0401
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA875586146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic