Provider Demographics
NPI:1346303286
Name:WESLEY, MARSHA ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:ANNETTE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3102
Mailing Address - Country:US
Mailing Address - Phone:718-258-5602
Mailing Address - Fax:718-258-5605
Practice Address - Street 1:1476 E 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3102
Practice Address - Country:US
Practice Address - Phone:718-258-5602
Practice Address - Fax:718-258-5605
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY88A891Medicare ID - Type Unspecified
NYB87340Medicare UPIN