Provider Demographics
NPI:1083619548
Name:GOLDEN, MARC S (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:S
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FIRST PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963
Mailing Address - Country:US
Mailing Address - Phone:207-873-8100
Mailing Address - Fax:207-873-8101
Practice Address - Street 1:107 FIRST PARK DRIVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963
Practice Address - Country:US
Practice Address - Phone:207-873-8100
Practice Address - Fax:207-873-8101
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1368207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002888OtherANTHEM
ME306520099Medicaid
MEMM3741Medicare PIN
ME002888OtherANTHEM
E86400Medicare UPIN
MEMM374101Medicare PIN