Provider Demographics
NPI:1588635023
Name:MARKOWITZ, MARIAN JEAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:JEAN
Last Name:MARKOWITZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GREATON DRIVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-465-8260
Mailing Address - Fax:401-455-0043
Practice Address - Street 1:260 OCEAN GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777
Practice Address - Country:US
Practice Address - Phone:508-676-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD1931213E00000X
MA1931213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11014168AMedicaid
MA0325643Medicaid
MAT78504Medicare UPIN
MAY70926Medicare PIN