Provider Demographics
NPI:1336102847
Name:MA, MARCUS (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:MA
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 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-3888
Mailing Address - Fax:419-383-2860
Practice Address - Street 1:3000 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-3888
Practice Address - Fax:419-383-2860
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15858C207P00000X
MEMD17582207P00000X
OH35-07-4098207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH810547599032Medicaid
OH727203OtherBCHP
OH2050855Medicaid
MI4443886Medicaid
OH000000271442OtherANTHEM
OH000000372959OtherANTHEM
OH930120175Medicare PIN
OH727203OtherBCHP
OHG62792Medicare UPIN
MI4443886Medicaid
OH810547599032Medicaid
OHMA0887885Medicare PIN