Provider Demographics
NPI:1871392928
Name:CARMICHAEL, MARC (PHD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:CARMICHAEL
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 VILLAGE CT APT 2
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3490
Mailing Address - Country:US
Mailing Address - Phone:732-397-3353
Mailing Address - Fax:
Practice Address - Street 1:2200 VILLAGE CT APT 2
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3490
Practice Address - Country:US
Practice Address - Phone:732-397-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program