Provider Demographics
NPI:1568474856
Name:NIERMAN, MARC L (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:L
Last Name:NIERMAN
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 1:54 HOPEDALE ST
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01747-1700
Mailing Address - Country:US
Mailing Address - Phone:508-473-6333
Mailing Address - Fax:508-634-0570
Practice Address - Street 1:54 HOPEDALE ST
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1700
Practice Address - Country:US
Practice Address - Phone:508-473-6333
Practice Address - Fax:508-634-0570
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47655208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27845OtherHARVARD PILGRIM
MA717468OtherTUFTS
MA0012997OtherNEIGHBORHOOD HEALTH PLAN
MA4677OtherFALLON
RI0000025365OtherRI BCBS
MA0184357Medicaid
MA70458OtherAETNA
MA1900202OtherUNITED HEALTH CARE
MA0012997OtherNEIGHBORHOOD HEALTH PLAN
MA0184357Medicaid