Provider Demographics
NPI:1255103073
Name:WRIGHT, MARC K
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:K
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARC
Other - Middle Name:K
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 STONEMOSS CT STE 302
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5731
Mailing Address - Country:US
Mailing Address - Phone:757-651-6644
Mailing Address - Fax:
Practice Address - Street 1:1520 STONEMOSS CT STE 302
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5731
Practice Address - Country:US
Practice Address - Phone:757-651-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA89193747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider