Provider Demographics
NPI:1538241989
Name:PAWSAT, MARC D (DPM)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:D
Last Name:PAWSAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 OLD MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056
Mailing Address - Country:US
Mailing Address - Phone:606-759-5686
Mailing Address - Fax:606-759-0368
Practice Address - Street 1:2011 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056
Practice Address - Country:US
Practice Address - Phone:606-759-5686
Practice Address - Fax:606-759-0368
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00213213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90110818OtherMEDICAID DME
KY80002132Medicaid
480022636OtherMEDICARE RR
U44344Medicare UPIN
KY80002132Medicaid
2012101Medicare ID - Type Unspecified