Healthcare Provider Details

I. General information

NPI: 1831155811
Provider Name (Legal Business Name): ANDREW J MARCUS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LAUREL MEADOW LN
CENTRE HALL PA
16828-7818
US

IV. Provider business mailing address

105 LAUREL MEADOW LN
CENTRE HALL PA
16828-7818
US

V. Phone/Fax

Practice location:
  • Phone: 814-404-6255
  • Fax:
Mailing address:
  • Phone: 814-404-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4779
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2164
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS007480L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: