Provider Demographics
NPI:1265432173
Name:MARVEL, JOHN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:MARVEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6100 W 96TH ST
Mailing Address - Street 2:STE 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6005
Mailing Address - Country:US
Mailing Address - Phone:317-715-1800
Mailing Address - Fax:317-715-6200
Practice Address - Street 1:1616 SMITH ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1264
Practice Address - Country:US
Practice Address - Phone:574-722-3650
Practice Address - Fax:574-722-5741
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN010353522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E15737Medicare UPIN
IN149720HMedicare PIN
IN215790CMedicare PIN