Provider Demographics
NPI:1942614979
Name:CALABRESE, MARC (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:CALABRESE
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 1:21 DONALD B DEAN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3234
Mailing Address - Country:US
Mailing Address - Phone:207-518-6600
Mailing Address - Fax:207-541-7445
Practice Address - Street 1:21 DONALD B DEAN DR STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3234
Practice Address - Country:US
Practice Address - Phone:207-518-6600
Practice Address - Fax:207-541-7445
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA259031390200000X
MEMD23704208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program