Provider Demographics
NPI:1164613881
Name:MARC L CHAIKEN, M.D., P.A.
Entity Type:Organization
Organization Name:MARC L CHAIKEN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAIKEN
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:410-730-6673
Mailing Address - Street 1:11055 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2896
Mailing Address - Country:US
Mailing Address - Phone:410-730-6673
Mailing Address - Fax:410-730-8226
Practice Address - Street 1:11055 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2896
Practice Address - Country:US
Practice Address - Phone:410-730-6673
Practice Address - Fax:410-730-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061604174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS935Medicare PIN