Provider Demographics
NPI:1831128727
Name:MARQUETTE, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MARQUETTE
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 1:5525 RESEARCH PARK DRIVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4664
Mailing Address - Country:US
Mailing Address - Phone:732-643-2070
Mailing Address - Fax:732-643-2015
Practice Address - Street 1:1515 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-3056
Practice Address - Country:US
Practice Address - Phone:732-295-0072
Practice Address - Fax:732-295-0224
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07324600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-09466OtherEVERCARE
NJ8765600Medicaid
5221142040OtherBCBS OF NJ
P00012169Medicare PIN
055382XNMMedicare PIN
04-09466OtherEVERCARE
NJ8765600Medicaid
055382MVKMedicare PIN