Provider Demographics
NPI:1487213526
Name:ANDUZE, MARCUS PATRICK
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:PATRICK
Last Name:ANDUZE
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 1:12006 MARION CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6053
Mailing Address - Country:US
Mailing Address - Phone:443-540-6298
Mailing Address - Fax:
Practice Address - Street 1:12006 MARION CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6053
Practice Address - Country:US
Practice Address - Phone:443-540-6298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA67346099347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle