MEDICARE: DR. PATRICIA L MARCUSON 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	0101048943	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00323504	OTHER		RR/MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	541634477076	OTHER	VA	TRICARE
2	28683	OTHER	VA	SENTARA/OPTIMA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	196181	OTHER	VA	ANTHEM
6	2820774001	OTHER	VA	CIGNA HEALTHCARE
7	8154300/3154300	OTHER	VA	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1609841485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA L MARCUSON M.D.

Provider Business Mailing Address
First Line	:	860 OMNI BLVD
Second Line	:	SUITE 303
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-232-8769
Fax Number	:	757-232-8875

Provider Business Practice Location Address
First Line	:	400 SENTARA CIR
Second Line	:	SUITE 400
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5716
Country	:	US
Telephone Number	:	757-645-3150
Fax Number	:	757-645-3149

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	10/05/2012

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Directions to “ DR. PATRICIA L MARCUSON M.D.” Practice Location

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