Provider Demographics
NPI:1508013301
Name:METH, MARC JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JEFFREY
Last Name:METH
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 1:2080 CENTURY PARK E STE 810
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2011
Mailing Address - Country:US
Mailing Address - Phone:310-556-1377
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 810
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2011
Practice Address - Country:US
Practice Address - Phone:310-556-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237973207KI0005X
CAA103999207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology