Provider Demographics
NPI:1811161102
Name:JOLICOEUR, MARC ETIENNE (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ETIENNE
Last Name:JOLICOEUR
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 1:2616 ERWIN RD
Mailing Address - Street 2:APT 1433
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3843
Mailing Address - Country:US
Mailing Address - Phone:919-943-5222
Mailing Address - Fax:919-668-7056
Practice Address - Street 1:2616 ERWIN RD
Practice Address - Street 2:APT 1433
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3843
Practice Address - Country:US
Practice Address - Phone:919-943-5222
Practice Address - Fax:919-668-7056
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program