MEDICARE: GREGORY Q MARSELLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME51261	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	04790	OTHER	FL	MEDICARE PTAN
3	04790A	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285721241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY Q MARSELLA M.D.

Provider Business Mailing Address
First Line	:	3648 MYKONOS CT
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1295
Country	:	US
Telephone Number	:	561-789-9922
Fax Number	:	561-210-1371

Provider Business Practice Location Address
First Line	:	8000 N FEDERAL HWY STE 110
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1681
Country	:	US
Telephone Number	:	561-394-2532
Fax Number	:	561-210-1371

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	04/01/2024

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