Provider Demographics
NPI:1114941150
Name:MARCUS, STEPHEN (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MARCUS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:307 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6679
Mailing Address - Country:US
Mailing Address - Phone:802-985-1272
Mailing Address - Fax:802-847-8158
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FLETCHER 4
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4044
Practice Address - Fax:802-847-8158
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT055-0030330208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)