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General NPI Number Information
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NPI Number | 1356387609
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Entity Type | Individual
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Provider Name | MARC C MCCULLOCH MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 205 E PALMER RD
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2281
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Country | US
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Telephone | 937-592-4015
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Fax |
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Provider Business Mailing Address
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Address Line | 266 MULADORE DR
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City | POWELL
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State | OH
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Zip | 43065-9388
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Country | US
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Telephone | 614-496-1355
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35052132
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License Number State | OH
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