Healthcare Provider Details

I. General information

NPI: 1568660652
Provider Name (Legal Business Name): MARIUS MARCEL COMMODORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 SAINT CHARLES AVE
NEW ORLEANS LA
70130-4445
US

IV. Provider business mailing address

1523 SAINT CHARLES AVE
NEW ORLEANS LA
70130-4445
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-1800
  • Fax: 215-707-3644
Mailing address:
  • Phone: 504-374-1000
  • Fax: 504-374-1350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD446997
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number115712
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number323144
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number323144
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number115712
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD446997
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: