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General NPI Number Information
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NPI Number | 1902262710
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Entity Type | Organization
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Legal Business Name | GARY B. MARCUS, M.D. - A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 1430 TARA HILLS DR SUITE A
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City | PINOLE
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State | CA
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Zip | 94564-2580
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Country | US
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Telephone | 510-640-0019
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Fax | 510-640-0021
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Provider Business Mailing Address
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Address Line | 1430 TARA HILLS DR SUITE A
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City | PINOLE
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State | CA
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Zip | 94564-2580
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Country | US
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Telephone | 510-640-0019
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Fax | 510-640-0021
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ESTELLA M OLSEN
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Credential |
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Telephone | 510-734-0677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C28611
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License Number State | CA
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