Provider Demographics
NPI:1376862904
Name:MARCUS, SUSAN BETH (OROFACIAL MYOLOGIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:MARCUS
Suffix:
Gender:F
Credentials:OROFACIAL MYOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 34TH STREET SOUTH
Mailing Address - Street 2:#154
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711
Mailing Address - Country:US
Mailing Address - Phone:727-954-6733
Mailing Address - Fax:309-405-6496
Practice Address - Street 1:719 PINELLAS BAYWAY S
Practice Address - Street 2:UNIT 201
Practice Address - City:TIERRA VERDE
Practice Address - State:FL
Practice Address - Zip Code:33715
Practice Address - Country:US
Practice Address - Phone:727-954-6733
Practice Address - Fax:309-405-6496
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist