Provider Demographics
NPI:1013069046
Name:MARCUM, BOBBY LEE (C-FNP)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:LEE
Last Name:MARCUM
Suffix:
Gender:M
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 HAL GREER BOULEVARD
Mailing Address - Street 2:ATTN: TAMMIE SILVA
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3800
Mailing Address - Country:US
Mailing Address - Phone:304-526-2200
Mailing Address - Fax:304-526-2139
Practice Address - Street 1:1340 HAL GREER BOULEVARD
Practice Address - Street 2:ATTN: TAMMIE SILVA
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3800
Practice Address - Country:US
Practice Address - Phone:304-526-2200
Practice Address - Fax:304-526-2139
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV47550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100115990Medicaid
OH3046877Medicaid
WVP00836672OtherRR MEDICARE
WV7103206000Medicaid
P40133Medicare UPIN
KY7100115990Medicaid