MEDICARE: DR. MARCELLA RUTH MCLARTY 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	208600000X	Surgery Physician	G69923	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00135617	OTHER		MEDICARE RAILROAD #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G69923	OTHER	CA	CA MEDICAL LICENSE
4	61148980	OTHER	WA	WA STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1841295706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELLA RUTH MCLARTY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1045
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95927-1045
Country	:	US
Telephone Number	:	530-809-2154
Fax Number	:	530-965-5508

Provider Business Practice Location Address
First Line	:	2485 NOTRE DAME BLVD
Second Line	:	SUITE 370-16
City	:	CHICO
State	:	CA
Zip	:	95928
Country	:	US
Telephone Number	:	530-809-2154
Fax Number	:	530-965-5598

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/07/2023

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