Healthcare Provider Details

I. General information

NPI: 1407813041
Provider Name (Legal Business Name): DENISE CLAIRE MARCOUX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 W CHESTNUT ST
BROCKTON MA
02301-5567
US

IV. Provider business mailing address

141 NURSERY RD
FALMOUTH MA
02540-2851
US

V. Phone/Fax

Practice location:
  • Phone: 508-583-3005
  • Fax:
Mailing address:
  • Phone: 508-548-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA646
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: