MEDICARE: NOACHIM MARCO 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	207R00000X	Internal Medicine Physician	G60305	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G60305	OTHER	CA	CA STATE LICENSE

General Provider Information

NPI Number	:	1366848335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOACHIM MARCO M.D.

Provider Business Mailing Address
First Line	:	7150 TAMPA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3700
Country	:	US
Telephone Number	:	818-774-3032
Fax Number	:	818-774-5919

Provider Business Practice Location Address
First Line	:	18855 VICTORY BLVD
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-6445
Country	:	US
Telephone Number	:	818-774-3032
Fax Number	:	818-774-5919

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

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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