Provider Demographics
NPI:1598859464
Name:WORKMAN, MARC ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ALAN
Last Name:WORKMAN
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 1:412 N LOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230
Mailing Address - Country:US
Mailing Address - Phone:606-638-4595
Mailing Address - Fax:606-638-9471
Practice Address - Street 1:412 N LOCK AVE
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-4595
Practice Address - Fax:606-638-9471
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64266315Medicaid
KY64266315Medicaid
1695001Medicare ID - Type Unspecified