Provider Demographics
NPI:1346276995
Name:DAOUD, MARJORIE THERMIDOR (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:THERMIDOR
Last Name:DAOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:THERMIDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:621 MEMORIAL DR STE 402
Mailing Address - Street 2:MEMORIAL HOSPITAL
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1074
Mailing Address - Country:US
Mailing Address - Phone:574-647-2500
Mailing Address - Fax:
Practice Address - Street 1:621 MEMORIAL DR STE 402
Practice Address - Street 2:MEMORIAL HOSPITAL
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1074
Practice Address - Country:US
Practice Address - Phone:574-647-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231214207R00000X, 207RI0200X
IN01072903A207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02624197Medicaid
NY02624197Medicaid
NYI26143Medicare UPIN