Provider Demographics
NPI:1316902869
Name:TUDOR, MARIN C (MD)
Entity type:Individual
Prefix:DR
First Name:MARIN
Middle Name:C
Last Name:TUDOR
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 1:3833 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2448
Mailing Address - Country:US
Mailing Address - Phone:914-337-2427
Mailing Address - Fax:
Practice Address - Street 1:3833 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2448
Practice Address - Country:US
Practice Address - Phone:718-639-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114828208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00210435Medicaid
NY313461Medicare PIN
NY00210435Medicaid