Provider Demographics
NPI:1295833515
Name:MARSELLA, MARCO N (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:N
Last Name:MARSELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4515 S MCCLINTOCK DR
Mailing Address - Street 2:STE 115
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7381
Mailing Address - Country:US
Mailing Address - Phone:520-834-7329
Mailing Address - Fax:520-743-9701
Practice Address - Street 1:8412 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6664
Practice Address - Country:US
Practice Address - Phone:520-834-7329
Practice Address - Fax:520-743-9701
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34216207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944951Medicaid
AZZ119465Medicare PIN
H77128Medicare UPIN