Provider Demographics
NPI:1891773677
Name:MARCARIAN, MATTHEW HERONT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HERONT
Last Name:MARCARIAN
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 1:8550 N SILVERY LN
Mailing Address - Street 2:SUITE B200
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8550 N SILVERY LN
Practice Address - Street 2:SUITE B200
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4510
Practice Address - Country:US
Practice Address - Phone:313-563-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI072206207R00000X
AZ23795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM78730003Medicare ID - Type Unspecified
MIG39410Medicare UPIN