Healthcare Provider Details

I. General information

NPI: 1265455349
Provider Name (Legal Business Name): MARCIL ESSA SALEM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 NATIONAL HEALTH DRIVE..DOPC VHC 00
DAYTONA BEACH FL
32114
US

IV. Provider business mailing address

551 NATIONAL HEALTH DRIVE..DOPC VHC 00
DAYTONA BEACH FL
32114
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7500
  • Fax:
Mailing address:
  • Phone: 386-323-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME67394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: