Provider Demographics
NPI:1396701322
Name:SKACEL, MAREK (MD)
Entity type:Individual
Prefix:
First Name:MAREK
Middle Name:
Last Name:SKACEL
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 1:417 STATE ST STE 439
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6635
Mailing Address - Country:US
Mailing Address - Phone:216-986-1314
Mailing Address - Fax:216-986-1191
Practice Address - Street 1:417 STATE ST STE 439
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6635
Practice Address - Country:US
Practice Address - Phone:216-986-1314
Practice Address - Fax:216-986-1191
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2443761Medicaid
OH2443761Medicaid