MEDICARE: GENE A MARCELLI JR. MD

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	MD026975E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00192302	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	468625	OTHER	PA	HIGHMARK BS

General Provider Information

NPI Number	:	1871576678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE A MARCELLI JR. MD

Provider Business Mailing Address
First Line	:	2425 GARDEN WAY
Second Line	:	SUITE 101
City	:	HERMITAGE
State	:	PA
Zip	:	16148-5215
Country	:	US
Telephone Number	:	724-981-0630
Fax Number	:	724-981-7379

Provider Business Practice Location Address
First Line	:	2425 GARDEN WAY
Second Line	:	SUITE 101
City	:	HERMITAGE
State	:	PA
Zip	:	16148-5215
Country	:	US
Telephone Number	:	724-981-0630
Fax Number	:	724-981-7379

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	07/07/2011

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Directions to “ GENE A MARCELLI JR. MD” Practice Location

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