Healthcare Provider Details

I. General information

NPI: 1285646257
Provider Name (Legal Business Name): MICHAEL A MARCOU D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E LITTLE CREEK RD
NORFOLK VA
23505-2603
US

IV. Provider business mailing address

210 MEADOW VIEW BLVD
SUFFOLK VA
23435-3495
US

V. Phone/Fax

Practice location:
  • Phone: 757-962-6769
  • Fax: 757-410-2658
Mailing address:
  • Phone: 757-673-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401007701
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: