MEDICARE: DR. DAVID A MARCOUX 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	MD07976	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0140182004	OTHER	RI	CIGNA
2	202696	OTHER	RI	BLUECHIP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	AA34962	OTHER		HARVARD PILGRIM HEALTH CARE
5	406226	OTHER	RI	TUFTS
6	1730140864	OTHER	RI	CHAMPUS
7	202696	OTHER	RI	BLUE CHIP OF RHODE ISLAND
8	21726-4	OTHER	RI	BLUE SHIELD OF RI ID#
9	2973	OTHER		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
10	04-07275	OTHER	RI	UNITEDHEALTHCARE
11	5117244	OTHER	RI	AETNA

General Provider Information

NPI Number	:	1730140864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A MARCOUX M.D.

Provider Business Mailing Address
First Line	:	407 EAST AVE STE 110
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-5299
Country	:	US
Telephone Number	:	401-725-4739
Fax Number	:	401-725-4740

Provider Business Practice Location Address
First Line	:	407 EAST AVE STE 110
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-5299
Country	:	US
Telephone Number	:	401-725-4739
Fax Number	:	401-725-4740

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	11/14/2025

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