MEDICARE: DR. ERIC HENRY MARCUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	AFE19220	CA

General Provider Information

NPI Number	:	1235362237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC HENRY MARCUS M.D.

Provider Business Mailing Address
First Line	:	2648 W CANYON AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4684
Country	:	US
Telephone Number	:	858-636-7841
Fax Number	:	858-636-7841

Provider Business Practice Location Address
First Line	:	2648 W CANYON AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4684
Country	:	US
Telephone Number	:	858-636-7841
Fax Number	:	858-636-7841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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