Provider Demographics
NPI:1801996442
Name:WARE, MARCUS L (MD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:L
Last Name:WARE
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 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:601-815-5034
Practice Address - Street 1:1514 JEFFERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4000
Practice Address - Fax:601-815-5034
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4893207T00000X
LAMD.201741207T00000X
CAA78198207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1025020Medicaid
AR5N592OtherBCBS
MS04524598Medicaid
AR162778001Medicaid
AR06070018300OtherQUALCHOICE
ARE4893OtherTRICARE
MS04524598Medicaid
ARE4893OtherTRICARE
LA4K8187061Medicare PIN