Provider Demographics
NPI:1073690210
Name:MARCUS, BRADLEY JESS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JESS
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:171 ASHLEY AVENUE, SUITE 309
Practice Address - Street 2:MEDICAL UNIVERSITY OF SOUTH CAROLINA, DEPT OF PATH
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29525-8905
Practice Address - Country:US
Practice Address - Phone:843-792-3121
Practice Address - Fax:843-792-3537
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25783207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology