Healthcare Provider Details

I. General information

NPI: 1528014347
Provider Name (Legal Business Name): DAVID STEVEN MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 EL CAMINO REAL
BURLINGAME CA
94010-3205
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-5515
  • Fax: 650-696-5280
Mailing address:
  • Phone: 415-884-3418
  • Fax: 415-883-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG63822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: