Basic Information
| Provider Information | |||||||||
| NPI: | 1861650590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BABAOFF | ||||||||
| FirstName: | MARCUS | ||||||||
| MiddleName: | ELIJAH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14883 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274154883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362746936 | ||||||||
| FaxNumber: | 3362750812 | ||||||||
| Practice Location | |||||||||
| Address1: | 603 DOLLEY MADISON RD # A | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274104283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362946190 | ||||||||
| FaxNumber: | 3362946278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 2009-01706 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 148745 | 01 | NC | STATE LICENSE | OTHER |