Provider Demographics
NPI:1740393289
Name:MARC ISERI MD PC
Entity Type:Organization
Organization Name:MARC ISERI MD PC
Other - Org Name:ISERI & ASSOCIATES UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:MUNROE
Authorized Official - Last Name:ISERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-889-7205
Mailing Address - Street 1:1077 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2125
Mailing Address - Country:US
Mailing Address - Phone:541-889-7205
Mailing Address - Fax:541-889-9204
Practice Address - Street 1:1077 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2125
Practice Address - Country:US
Practice Address - Phone:541-889-7205
Practice Address - Fax:541-889-9204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417909599OtherNPI, DR. MARC ISERI
OR093682Medicaid
1417909599OtherNPI, DR. MARC ISERI
C92940Medicare UPIN