Healthcare Provider Details

I. General information

NPI: 1174522320
Provider Name (Legal Business Name): DAVID HAROLD MARCOWITZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 7TH ST SUITE 100
CHARITON IA
50049-1210
US

IV. Provider business mailing address

1200 N 7TH ST SUITE 100
CHARITON IA
50049-1210
US

V. Phone/Fax

Practice location:
  • Phone: 641-774-8103
  • Fax: 641-774-8087
Mailing address:
  • Phone: 641-774-8103
  • Fax: 641-774-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036082773
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3281
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: