1477680114 NPI number — MARC A JEROME MD

Table of content: MARC A JEROME MD (NPI 1477680114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477680114 NPI number — MARC A JEROME MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEROME
Provider First Name:
MARC
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477680114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25537
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANSTED
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00824-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-713-9002
Provider Business Mailing Address Fax Number:
340-713-0215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 RUBY PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHRISTIANSTED
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-778-5777
Provider Business Practice Location Address Fax Number:
340-778-3161
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  1041 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: VI LICENSE . This is a "1041" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com