Provider Demographics
NPI:1811940224
Name:STANBRO, MARCUS DUANE (DO)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:DUANE
Last Name:STANBRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE B260
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6328
Practice Address - Country:US
Practice Address - Phone:864-454-2852
Practice Address - Fax:864-454-2899
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC662202K00000X
SC6222086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT00808Medicaid
SCP00802362OtherRR MEDICARE
SCE932816904Medicare PIN
SCP00802362OtherRR MEDICARE
SCT00808Medicaid