Provider Demographics
NPI:1225020951
Name:MARASCO, PATRICK V JR (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:V
Last Name:MARASCO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:43 HIGH ST
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2646
Mailing Address - Country:US
Mailing Address - Phone:978-687-3242
Mailing Address - Fax:978-208-8414
Practice Address - Street 1:43 HIGH ST
Practice Address - Street 2:SUITE 110B
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2646
Practice Address - Country:US
Practice Address - Phone:978-687-3242
Practice Address - Fax:978-208-8414
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2015-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA561062086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1225020951OtherMEDICARE MD
MA706025OtherTUFTS
MAJ05874OtherBLUE SHIELD
MA3006620Medicaid
MAM20120OtherMEDICARE CORP
MA3006620Medicaid
MA1518153071Medicare NSC