Provider Demographics
NPI:1326036591
Name:MARUCHECK, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:MARUCHECK
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 1:6217 DRESDEN LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2336
Mailing Address - Country:US
Mailing Address - Phone:919-855-8911
Mailing Address - Fax:919-855-9424
Practice Address - Street 1:3320 WAKE FOREST RD
Practice Address - Street 2:SUITE 310
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7300
Practice Address - Country:US
Practice Address - Phone:919-855-8911
Practice Address - Fax:919-855-9424
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954546Medicaid
NC202543AMedicare ID - Type Unspecified
NCC81327Medicare UPIN
NC202543DMedicare PIN