Provider Demographics
NPI:1043365810
Name:MARCELLI, RUDY JAMES (DMD)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:JAMES
Last Name:MARCELLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4323
Mailing Address - Country:US
Mailing Address - Phone:814-944-0607
Mailing Address - Fax:814-944-0587
Practice Address - Street 1:305 CAYUGA AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4323
Practice Address - Country:US
Practice Address - Phone:814-944-0607
Practice Address - Fax:814-944-0587
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029888L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100997181001Medicare ID - Type Unspecified