Provider Demographics
NPI:1053372912
Name:MARMADUKE, DAVID PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PATRICK
Last Name:MARMADUKE
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 1:3059 S MARYLAND PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-6209
Mailing Address - Country:US
Mailing Address - Phone:702-732-3441
Mailing Address - Fax:702-732-2310
Practice Address - Street 1:3059 S MARYLAND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-6209
Practice Address - Country:US
Practice Address - Phone:702-732-3441
Practice Address - Fax:702-732-2310
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10192207ZH0000X, 207ZP0102X
CAG86741207ZH0000X
OH35066478207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200225022Medicaid
NV200225022Medicaid
NV220032781Medicare PIN
NVV36634Medicare PIN