Healthcare Provider Details

I. General information

NPI: 1609160563
Provider Name (Legal Business Name): MARSHALL BERNARD MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 49TH ST N STE 200
ST PETERSBURG FL
33709-2149
US

IV. Provider business mailing address

6006 49TH ST N STE 200
ST PETERSBURG FL
33709-2149
US

V. Phone/Fax

Practice location:
  • Phone: 727-490-2100
  • Fax: 855-222-3965
Mailing address:
  • Phone: 727-490-2100
  • Fax: 855-222-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP26497
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME122508
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME122508
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: