Healthcare Provider Details

I. General information

NPI: 1528287851
Provider Name (Legal Business Name): MARCELLA MADERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCELLA KOCH

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 BEE CAVES RD BLDG C STE. 101
AUSTIN TX
78746
US

IV. Provider business mailing address

3000 N IH 35 STE 600
AUSTIN TX
78705-1850
US

V. Phone/Fax

Practice location:
  • Phone: 512-212-4865
  • Fax: 737-220-2520
Mailing address:
  • Phone: 512-306-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberN9735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: