Active NPI
Jac Daniel Marden, MD
- Dermatology Physician
- Wailuku, HI
National Provider Identifier
1548250277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- ME0071733
- Practice address
- 99 S Market St Ste 206
Wailuku, HI 96793-2259 - Phone
- (808) 249-8600
- NPI assigned
- Oct 25, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | ME0071733 | FL | Primary |
Addresses
Primary practice location
99 S Market St Ste 206
Wailuku, HI 96793-2259
Mailing address
99 S Market St Ste 206
Wailuku, HI 96793-2259
Phone (808) 249-8600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0071733 | FL | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226620800000",
"number": "1548250277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "99 S MARKET ST STE 206",
"city": "WAILUKU",
"state": "HI",
"postal_code": "967932259",
"telephone_number": "808-249-8600",
"fax_number": "561-659-0495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "99 S MARKET ST STE 206",
"city": "WAILUKU",
"state": "HI",
"postal_code": "967932259",
"telephone_number": "808-249-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARDEN",
"first_name": "JAC",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-25",
"last_updated": "2008-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "FL",
"license": "ME0071733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wailuku, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.