Provider Demographics
NPI:1326205592
Name:MARCONI, PATRI MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRI
Middle Name:MARIE
Last Name:MARCONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GORDON GUTMANN BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3764
Mailing Address - Country:US
Mailing Address - Phone:812-282-0637
Mailing Address - Fax:812-283-6330
Practice Address - Street 1:301 GORDON GUTMANN BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3764
Practice Address - Country:US
Practice Address - Phone:812-282-0637
Practice Address - Fax:812-283-6330
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052331390200000X
IN01072571A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program