MEDICARE: JULIE PETERSEN MARCINEK DO

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	207Q00000X	Family Medicine Physician	34012862	OH
2	207Q00000X	Family Medicine Physician	DO034562	DC
3	207Q00000X	Family Medicine Physician	H0081197	MD
4	207Q00000X	Family Medicine Physician	3508	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H596080	OTHER	OH	MEDICARE

General Provider Information

NPI Number	:	1649513367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE PETERSEN MARCINEK DO

Provider Business Mailing Address
First Line	:	702 PROFESSIONAL PARK
Second Line	:	SUITE 104
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651
Country	:	US
Telephone Number	:	304-872-0089
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 PROFESSIONAL PARK DR STE 104
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-2033
Country	:	US
Telephone Number	:	304-872-0089
Fax Number	:

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

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	03/02/2026

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