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General NPI Number Information
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NPI Number | 1285087684
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Entity Type | Individual
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Provider Name | MR. ANDREW MARCARELLI
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Gender | Male
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 29 BLACK COAL DR
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City | FT WASHAKIE
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State | WY
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Zip | 82514
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Country | US
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Telephone | 307-332-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 696 CANYON ST
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City | LANDER
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State | WY
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Zip | 82520-3230
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Country | US
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Telephone | 714-475-4227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 365673
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License Number State | CO
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