Provider Demographics
NPI:1427017417
Name:ZYIREK-BACON, MARJORIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:ZYIREK-BACON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3134
Mailing Address - Country:US
Mailing Address - Phone:207-662-3500
Mailing Address - Fax:207-662-6006
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-3500
Practice Address - Fax:207-662-6006
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD26026207RC0000X, 207RH0002X
MA76871207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
076871OtherTUFTS HEALTH PLAN
MAJ13099OtherBCBS
060066747OtherRR MEDICARE
MA3102041Medicaid
94964OtherFALLON
0011646OtherNEIGHBORHOOD HEALTH PLAN
300273OtherHPHC
MA3102041Medicaid
300273OtherHPHC