Provider Demographics
NPI:1740573484
Name:GUERRA, MARC PETER (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:PETER
Last Name:GUERRA
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 1:1766 CONNELLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-7827
Mailing Address - Country:US
Mailing Address - Phone:828-728-8224
Mailing Address - Fax:828-728-1690
Practice Address - Street 1:1766 CONNELLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-7827
Practice Address - Country:US
Practice Address - Phone:828-728-8224
Practice Address - Fax:828-728-1690
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740573484Medicaid