MEDICARE: MR. JEFFREY D MARCOTTE P.A.

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	363A00000X	Physician Assistant	0110011261	VA
2	363A00000X	Physician Assistant	215389	NC

General Provider Information

NPI Number	:	1457650699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY D MARCOTTE P.A.

Provider Business Mailing Address
First Line	:	PO BOX 749112
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 LEE ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22908-0816
Country	:	US
Telephone Number	:	434-924-9333
Fax Number	:

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	02/06/2026

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