Healthcare Provider Details

I. General information

NPI: 1902545718
Provider Name (Legal Business Name): ELEONORA MARIE MARCACCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 E 2900 S
SALT LAKE CITY UT
84109-1842
US

IV. Provider business mailing address

2613 E 2900 S
SALT LAKE CITY UT
84109-1842
US

V. Phone/Fax

Practice location:
  • Phone: 801-712-8325
  • Fax:
Mailing address:
  • Phone: 801-712-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.259213
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: