Provider Demographics
NPI:1164408506
Name:SIMMONS, MARC D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:SIMMONS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 GENERAL ST
Mailing Address - Street 2:ANDREA SULLIVAN-DIRECTOR OF MANAGED CARE DEPT.
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2961
Mailing Address - Country:US
Mailing Address - Phone:978-683-4000
Mailing Address - Fax:978-946-8026
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:ANDREA SULLIVAN-DIRECTOR OF MANAGED CARE DEPT.
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2961
Practice Address - Country:US
Practice Address - Phone:978-683-4000
Practice Address - Fax:978-946-8026
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-07-20
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Provider Licenses
StateLicense IDTaxonomies
MA204773207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH07545Medicare UPIN