Provider Demographics
NPI:1013513969
Name:BANDMAN, MARC BENJAMIN
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:BENJAMIN
Last Name:BANDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 BOXWOOD TER
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3125
Mailing Address - Country:US
Mailing Address - Phone:614-214-8612
Mailing Address - Fax:
Practice Address - Street 1:6604 QUAIL LK
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7001
Practice Address - Country:US
Practice Address - Phone:614-214-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361654Medicaid