Provider Demographics
NPI:1295733624
Name:FROST, MARC L (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:FROST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4802 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1750
Mailing Address - Country:US
Mailing Address - Phone:317-446-7404
Mailing Address - Fax:317-875-6894
Practice Address - Street 1:4802 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1750
Practice Address - Country:US
Practice Address - Phone:317-446-7404
Practice Address - Fax:317-875-6894
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-10
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01036233207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND46951Medicare UPIN
IN249180Medicare PIN