Provider Demographics
NPI:1275312043
Name:MARCUS, STEPHEN HAMILTON (PRSS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HAMILTON
Last Name:MARCUS
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 QUARRIER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2410
Mailing Address - Country:US
Mailing Address - Phone:304-416-9039
Mailing Address - Fax:
Practice Address - Street 1:705 S PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2629
Practice Address - Country:US
Practice Address - Phone:304-446-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23-9154175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist