Healthcare Provider Details

I. General information

NPI: 1891790705
Provider Name (Legal Business Name): MARC H INCERPI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/27/2023
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 435
BURBANK CA
91505-4551
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-5802
  • Fax:
Mailing address:
  • Phone: 818-845-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG77155
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG77155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: