Provider Demographics
NPI:1407897770
Name:DUBIN, MARC G (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:G
Last Name:DUBIN
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 1:6565 N CHARLES ST STE 601
Mailing Address - Street 2:PHYSICIANS PAVILION EAST
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5801
Mailing Address - Country:US
Mailing Address - Phone:410-821-5151
Mailing Address - Fax:
Practice Address - Street 1:6565 N CHARLES ST STE 601
Practice Address - Street 2:PHYSICIANS PAVILION EAST
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5801
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62319207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKR60L681Medicare ID - Type Unspecified
MDI09771Medicare UPIN