Provider Demographics
NPI:1265532139
Name:MARDEN, MICHAEL E (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:MARDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4403
Mailing Address - Country:US
Mailing Address - Phone:207-236-8879
Mailing Address - Fax:207-236-3885
Practice Address - Street 1:377 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4403
Practice Address - Country:US
Practice Address - Phone:207-236-8879
Practice Address - Fax:207-236-3885
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT591152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME005978OtherANTHEM
MEMNT161OtherHARVARD PILGRIM
710083Medicare ID - Type Unspecified
ME005978OtherANTHEM