Provider Demographics
NPI:1942273826
Name:DICK, MAROUN T (MD)
Entity Type:Individual
Prefix:DR
First Name:MAROUN
Middle Name:T
Last Name:DICK
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 1:8577 CORDES CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3317
Mailing Address - Country:US
Mailing Address - Phone:901-590-0886
Mailing Address - Fax:901-590-0071
Practice Address - Street 1:8577 CORDES CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-3317
Practice Address - Country:US
Practice Address - Phone:901-590-0886
Practice Address - Fax:901-590-0071
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 0195312084N0400X, 2084N0600X
TN195312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729834Medicaid
E88445Medicare UPIN
3050949Medicare ID - Type UnspecifiedINDIVIDUAL