Provider Demographics
NPI:1851318885
Name:RICKFORD, MARC STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:STEVEN
Last Name:RICKFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:DEPAUL BLDG-SUITE 110
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2104
Mailing Address - Country:US
Mailing Address - Phone:202-448-4080
Mailing Address - Fax:202-448-4082
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:DEPAUL BLDG-SUITE 110
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2104
Practice Address - Country:US
Practice Address - Phone:202-448-4080
Practice Address - Fax:202-448-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD33973174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410085900Medicaid
MDH92334Medicare UPIN
MD410085900Medicaid