Provider Demographics
NPI:1396765947
Name:PRINCE, MARVIN (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6099
Mailing Address - Country:US
Mailing Address - Phone:203-797-7038
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-797-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013317207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY543619OtherNYS MEDICAID
CT040388OtherHEALTH NET
CT1133172Medicaid
CT547771OtherCIGNA HEALTHCARE
CTZP021OtherOXFORD HEALTH PLANS
CT586016OtherUNITED HEALTHCARE
CT2180483OtherAETNA U.S. HEALTHCARE
CT732191OtherCONNECTICARE
NY90658OtherEMPIRE PPO INDEMNITY
CT010013317CT01OtherANTHEM
CT586016OtherUNITED HEALTHCARE