Active NPI
Paul Marusov, MD
- Pediatrics Physician
- East Lyme, CT
National Provider Identifier
1699747832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 025201
- Practice address
- 76 Spring Rock Rd
East Lyme, CT 06333-1440 - Phone
- (860) 739-2407
- NPI assigned
- Feb 2, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 025201 | CT | Primary |
Addresses
Primary practice location
76 Spring Rock Rd
East Lyme, CT 06333-1440
Mailing address
76 Spring Rock Rd
East Lyme, CT 06333-1440
Phone (860) 739-2407
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 |
|---|---|---|---|
| 025201 | CT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Physicians PC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699747832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 SPRING ROCK RD",
"city": "EAST LYME",
"state": "CT",
"postal_code": "063331440",
"telephone_number": "860-739-2407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 SPRING ROCK RD",
"city": "EAST LYME",
"state": "CT",
"postal_code": "063331440",
"telephone_number": "860-739-2407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARUSOV",
"first_name": "PAUL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "025201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Lyme, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.