Provider Demographics
NPI:1427017417
Name:ZYIREK-BACON, MARJORIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:ZYIREK-BACON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4235
Mailing Address - Country:US
Mailing Address - Phone:073-013-0902
Mailing Address - Fax:
Practice Address - Street 1:4 GLEN COVE DR STE 204
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:073-013-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76871207RC0000X
MEMD26026207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
076871OtherTUFTS HEALTH PLAN
MAJ13099OtherBCBS
060066747OtherRR MEDICARE
MA3102041Medicaid
94964OtherFALLON
0011646OtherNEIGHBORHOOD HEALTH PLAN
300273OtherHPHC
MA3102041Medicaid
300273OtherHPHC