Provider Demographics
NPI:1841535192
Name:MARC J. METH, M.D., INC.
Entity type:Organization
Organization Name:MARC J. METH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:METH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-556-1377
Mailing Address - Street 1:2080 CENTURY PARK E STE 810
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2011
Mailing Address - Country:US
Mailing Address - Phone:310-556-1377
Mailing Address - Fax:310-556-1650
Practice Address - Street 1:2080 CENTURY PARK EAST STE. 810
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2011
Practice Address - Country:US
Practice Address - Phone:310-556-1377
Practice Address - Fax:310-556-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103999207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CF6742Medicare UPIN