Basic Information
Provider Information | |||||||||
NPI: | 1881616647 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MARCUS | ||||||||
FirstName: | MADELINE | ||||||||
MiddleName: | ESTHER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1515 SPRINGFIELD DR | ||||||||
Address2: |   | ||||||||
City: | CHICO | ||||||||
State: | CA | ||||||||
PostalCode: | 959285995 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3078114405 | ||||||||
FaxNumber: | 3026514945 | ||||||||
Practice Location | |||||||||
Address1: | 801 MIDDLEFORD RD | ||||||||
Address2: |   | ||||||||
City: | SEAFORD | ||||||||
State: | DE | ||||||||
PostalCode: | 199733636 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3026296611 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/24/2006 | ||||||||
LastUpdateDate: | 09/07/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | G079237 | CA | N |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 208M00000X | C10011062 | DE | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 208000000X | G079237 | CA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.