Provider Demographics
NPI:1790842508
Name:MARC N DUBICK MD PC
Entity Type:Organization
Organization Name:MARC N DUBICK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:N
Authorized Official - Last Name:DUBICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-697-1671
Mailing Address - Street 1:835 DUCK HAWK RETREAT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-697-1671
Mailing Address - Fax:844-406-4501
Practice Address - Street 1:835 DUCK HAWK RETREAT
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-697-1671
Practice Address - Fax:844-406-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1992705826OtherNPI ASSOCIATED WITH SS#
SCC72601Medicare UPIN
SC8325Medicare ID - Type UnspecifiedGROUP NUMBER