Provider Demographics
NPI:1285655282
Name:NDIKUM, MARINUS C (DO)
Entity Type:Individual
Prefix:
First Name:MARINUS
Middle Name:C
Last Name:NDIKUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:717 STATE ST
Mailing Address - Street 2:SUITE 16 LL
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:201 STATE STREET
Practice Address - Street 2:HAMOT RADIOLOGY
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550
Practice Address - Country:US
Practice Address - Phone:814-877-6000
Practice Address - Fax:814-877-6149
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0122142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology