Provider Demographics
NPI:1881624997
Name:MARCUS, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MARCUS
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 1:39 DANTE ST
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1608
Mailing Address - Country:US
Mailing Address - Phone:914-834-4669
Mailing Address - Fax:
Practice Address - Street 1:262 E 174TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7152
Practice Address - Country:US
Practice Address - Phone:718-299-6910
Practice Address - Fax:347-649-3038
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87412Medicare UPIN
NY44F322Medicare ID - Type Unspecified