MEDICARE: DR. DAVID CHARLES MARZULO D.O.

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	2084N0400X	Neurology Physician	3228	AZ

General Provider Information

NPI Number	:	1699771600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CHARLES MARZULO D.O.

Provider Business Mailing Address
First Line	:	1919 E MCKELLIPS RD
Second Line	:	STE 102
City	:	MESA
State	:	AZ
Zip	:	85203-2844
Country	:	US
Telephone Number	:	480-834-9575
Fax Number	:	480-834-4497

Provider Business Practice Location Address
First Line	:	1919 E MCKELLIPS RD
Second Line	:	STE 102
City	:	MESA
State	:	AZ
Zip	:	85203-2844
Country	:	US
Telephone Number	:	480-834-9575
Fax Number	:	480-834-4497

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/04/2014

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