Healthcare Provider Details

I. General information

NPI: 1023378494
Provider Name (Legal Business Name): MARCELO EDUARDO RAINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2012
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET UMMC NEONATOLOGY
JACKSON MS
39216
US

IV. Provider business mailing address

1970 HOSPITAL DR
CLARKSDALE MS
38614-7202
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-1000
  • Fax:
Mailing address:
  • Phone: 662-627-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35C.001315
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23907
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: