MEDICARE: MARK A. MARCONI, D.O., P.A.

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	207Q00000X	Family Medicine Physician	K9342	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447473319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK A. MARCONI, D.O., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1128
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-1128
Country	:	US
Telephone Number	:	979-532-1159
Fax Number	:	979-532-2119

Provider Business Practice Location Address
First Line	:	10119 US 59 HWY
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-7224
Country	:	US
Telephone Number	:	979-532-1159
Fax Number	:	979-532-2119

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK A MARCONI
Credential	:	D.O.
Telephone Number	:	979-532-1159

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/21/2022

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