Provider Demographics
NPI:1134116007
Name:CEPHAS, MARCELLUS R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLUS
Middle Name:R
Last Name:CEPHAS
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 1:327 ORISKANY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1422
Mailing Address - Country:US
Mailing Address - Phone:315-768-7181
Mailing Address - Fax:315-768-7182
Practice Address - Street 1:327 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1422
Practice Address - Country:US
Practice Address - Phone:315-768-7181
Practice Address - Fax:315-768-7182
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207888174400000X
MDD0059532174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01769407Medicaid
MD4022891Medicaid
NY040426031578OtherFIDELIS
NY629706OtherUNITED HEALTH CARE
NY073987OtherEMPIRE
NY3000911OtherMVP
NY629706OtherUNITED HEALTH CARE
NY040426031578OtherFIDELIS
MD4022891Medicaid