Provider Demographics
NPI:1326240409
Name:MARCHELEOVICH, MARLO H (DO)
Entity Type:Individual
Prefix:DR
First Name:MARLO
Middle Name:H
Last Name:MARCHELEOVICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 S PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2262
Mailing Address - Country:US
Mailing Address - Phone:814-445-3575
Mailing Address - Fax:814-445-8039
Practice Address - Street 1:229 S KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2022
Practice Address - Country:US
Practice Address - Phone:814-445-3575
Practice Address - Fax:814-445-8039
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021637230001Medicaid
PA1021637230001Medicaid