Provider Demographics
NPI:1265466791
Name:THORNE, MARCUS ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ALI
Last Name:THORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0760
Mailing Address - Country:US
Mailing Address - Phone:812-254-7310
Mailing Address - Fax:812-257-8602
Practice Address - Street 1:421 E VAN TREES ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2948
Practice Address - Country:US
Practice Address - Phone:812-254-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060526A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200520340Medicaid
IN207610QQQOtherMEDICARE
INP00438892OtherRR MEDICARE
IN000000527888OtherANTHEM
INP00929838OtherRR MEDICARE
IN207610QQQOtherMEDICARE
IN200520340Medicaid