Provider Demographics
NPI:1578382602
Name:VIRGIN, MARCUS
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:VIRGIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 E CAMPUS VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4634
Mailing Address - Country:US
Mailing Address - Phone:614-206-7605
Mailing Address - Fax:
Practice Address - Street 1:246 E CAMPUS VIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4634
Practice Address - Country:US
Practice Address - Phone:614-505-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005377175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist