Provider Demographics
NPI:1386003762
Name:CLAPP, MARC
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:CLAPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95A POWNAL RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-5711
Mailing Address - Country:US
Mailing Address - Phone:817-797-1177
Mailing Address - Fax:
Practice Address - Street 1:95A POWNAL RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-5711
Practice Address - Country:US
Practice Address - Phone:817-797-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN37129390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program