Individual
JEREMIAH RICHARD MARION III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4102 N ROXBORO ST, DURHAM, NC 27704-2122
(919) 595-2106
(919) 595-2190
Mailing address
4102 N ROXBORO RD, DURHAM, NC 27704
(919) 595-2000
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
20493
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0852212
UNITED HEALTHCARE
NC
01
—
19473
OPTICARE
NC
01
—
346159
MAMSI
NC
01
—
4540374
AETNA
NC
01
—
52628
MEDCOST
NC
01
—
53935
BCBS NC
NC
01
—
5612887675
CIGNA
NC
Enumeration date
08/02/2005
Last updated
12/04/2007
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