Marvin Antonio Porfiro Sison Duque, M.D.

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

242096 Issued in MA

Practice address

4901 Lang Ave NE
Albuquerque, NM 87109-4495

Phone

(505) 842-8171

NPI assigned

Sep 12, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physician Services Corporation of Southern Illinois Inc.

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  Medicare reassignment NPD
• Rockford Health Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462838400000",
    "number": "1659520823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 LANG AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094495",
            "telephone_number": "505-842-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 LANG AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094495",
            "telephone_number": "505-842-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUQUE",
        "first_name": "MARVIN ANTONIO",
        "middle_name": "PORFIRO SISON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-12",
        "last_updated": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "016621A",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MA",
            "license": "242096",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NM",
            "license": "MD2016-0099",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "76806057",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200934840",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jimmy Duong
• Mylinh Duong
• Daniel Dupont
• Tara Lynn Dupont, M.D.
• Starla D Dupre, CNM
• Siddarth Durairajan, MBBS
• Duran Central Pharmacy, Inc.
• Francesca Stephanie Duran-Lopez, DS1
• Rachel B Duran-Strong, SW
• Alexis Duran

• Hematology & Oncology Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Hematology & Oncology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.