Healthcare Provider Details

I. General information

NPI: 1669518189
Provider Name (Legal Business Name): FRED S MARCUS, M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 WHIPPLE AVE SUITE B
REDWOOD CITY CA
94062-2857
US

IV. Provider business mailing address

2940 WHIPPLE AVE SUITE B
REDWOOD CITY CA
94062-2857
US

V. Phone/Fax

Practice location:
  • Phone: 650-216-8300
  • Fax: 650-216-8400
Mailing address:
  • Phone: 650-216-8300
  • Fax: 650-216-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FRED S MARCUS
Title or Position: OWNER
Credential: M.D.
Phone: 650-216-8300