Healthcare Provider Details

I. General information

NPI: 1538107701
Provider Name (Legal Business Name): MICHAEL C MARCUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 GERMANTOWN AVE
PHILADELPHIA PA
19118-2722
US

IV. Provider business mailing address

3500 N BROAD ST # 1A
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-8877
  • Fax: 215-836-5372
Mailing address:
  • Phone: 215-707-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD033924E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD033924E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: