Provider Demographics
NPI:1740963586
Name:MEUTH, MARC ALLAN
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ALLAN
Last Name:MEUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 PLEASANT VALLEY RD N APT 301
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2562
Mailing Address - Country:US
Mailing Address - Phone:512-638-9894
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 159, TROUTE AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:512-638-9894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman