Provider Demographics
NPI:1467533745
Name:MAGOD, MARC E (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:E
Last Name:MAGOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-378-0713
Mailing Address - Fax:336-273-9060
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1439
Practice Address - Country:US
Practice Address - Phone:336-378-0713
Practice Address - Fax:336-273-9060
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC35417207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8953729Medicaid
NC42501OtherMEDCOST
NC2110OtherPARTNERS MEDICARE
NC53729OtherBCBS OF NC
NC2173261CMedicare PIN
NC2110OtherPARTNERS MEDICARE
NC100013171Medicare PIN