Provider Demographics
NPI:1992705826
Name:DUBICK, MARC NATHAN (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:NATHAN
Last Name:DUBICK
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 1:835 DUCK HAWK RETREAT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412
Mailing Address - Country:US
Mailing Address - Phone:843-697-1671
Mailing Address - Fax:844-406-4501
Practice Address - Street 1:835 DUCK HAWK RETREAT
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412
Practice Address - Country:US
Practice Address - Phone:843-697-1671
Practice Address - Fax:844-406-4501
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2018-11-14
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
SCSC20700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC72601Medicare UPIN