MEDICARE: MARIUS MARCEL COMMODORE MD

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	115712	IL
2	207R00000X	Internal Medicine Physician	MD446997	PA
3	2084P0800X	Psychiatry Physician	MD446997	PA
4	2084P0800X	Psychiatry Physician	115712	IL
5	2084P0800X	Psychiatry Physician	323144	LA
6	207R00000X	Internal Medicine Physician	323144	LA

General Provider Information

NPI Number	:	1568660652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIUS MARCEL COMMODORE MD

Provider Business Mailing Address
First Line	:	1523 SAINT CHARLES AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70130-4445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1523 SAINT CHARLES AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70130-4445
Country	:	US
Telephone Number	:	215-707-1800
Fax Number	:	215-707-3644

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	04/24/2025

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Directions to “ MARIUS MARCEL COMMODORE MD” Practice Location

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