Provider Demographics
NPI:1275652745
Name:PELOSI, MARCO ANTONIO II (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:ANTONIO
Last Name:PELOSI
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1313
Mailing Address - Country:US
Mailing Address - Phone:201-858-1800
Mailing Address - Fax:201-858-1002
Practice Address - Street 1:350 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1313
Practice Address - Country:US
Practice Address - Phone:201-858-1800
Practice Address - Fax:201-858-1002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02710500207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PE421999Medicare PIN
NJC54214Medicare UPIN