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General NPI Number Information
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NPI Number | 1437780335
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Entity Type | Organization
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Legal Business Name | MARCELLUS MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 1/2 ORANGE ST
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City | MARCELLUS
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State | NY
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Zip | 13108-1216
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Country | US
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Telephone | 317-673-1529
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Fax | 315-673-2434
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Provider Business Mailing Address
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Address Line | 1/2 ORANGE ST
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City | MARCELLUS
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State | NY
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Zip | 13108-1216
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Country | US
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Telephone | 317-673-1529
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Fax | 315-673-2434
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | KHATUNA N STEPKOVITCH
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Credential | MD
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Telephone | 315-673-1529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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