Provider Demographics
NPI:1851350649
Name:COBB, MARCUS L (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:L
Last Name:COBB
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 1:120 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1116
Mailing Address - Country:US
Mailing Address - Phone:812-537-5616
Mailing Address - Fax:812-537-1804
Practice Address - Street 1:120 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1116
Practice Address - Country:US
Practice Address - Phone:812-537-5616
Practice Address - Fax:812-537-1804
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0803787Medicaid
OH0803787Medicaid
IN151000JMedicare PIN
OHCO0676792Medicare ID - Type Unspecified