Provider Demographics
NPI:1033616941
Name:BOZYCH, MARC (DO)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:BOZYCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PARNASSUS AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2206
Mailing Address - Country:US
Mailing Address - Phone:415-476-9035
Mailing Address - Fax:415-353-9163
Practice Address - Street 1:521 PARNASSUS AVE FL 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2206
Practice Address - Country:US
Practice Address - Phone:415-476-9035
Practice Address - Fax:415-353-9163
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016010207L00000X, 207LP2900X, 207LP3000X
CA20A17673207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0495744Medicaid