Healthcare Provider Details

I. General information

NPI: 1316064116
Provider Name (Legal Business Name): CAROL SILBER MARCUS PH.D., M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B265 UCLA DEPT OF RADIATION ONCOLOGY 200 MEDICAL PLAZA
LOS ANGELES CA
90095-6951
US

IV. Provider business mailing address

1877 COMSTOCK AVE
LOS ANGELES CA
90025-5014
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9775
  • Fax: 310-794-9795
Mailing address:
  • Phone: 310-277-4541
  • Fax: 310-552-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberG37890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: