Basic Information
| Provider Information | |||||||||
| NPI: | 1477059509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSEILLE | ||||||||
| FirstName: | URIELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 HAWLEY LN FL 3 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066141202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035024650 | ||||||||
| FaxNumber: | 4752469894 | ||||||||
| Practice Location | |||||||||
| Address1: | 196 PARKWAY S | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | WATERFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604376764 | ||||||||
| FaxNumber: | 8608652392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 08/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 68065 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 68065 | 01 | CT | LICENSE | OTHER | 1477059509 | 05 | CT | MEDICAID |