Provider Demographics
NPI:1427406917
Name:JASON MARCHETTI MD PA
Entity Type:Organization
Organization Name:JASON MARCHETTI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-307-5109
Mailing Address - Street 1:600 W CAMPBELL RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3357
Mailing Address - Country:US
Mailing Address - Phone:469-307-5109
Mailing Address - Fax:888-417-4939
Practice Address - Street 1:3319 UNICORN LAKE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0120
Practice Address - Country:US
Practice Address - Phone:469-307-5109
Practice Address - Fax:888-417-4939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASON MARCHETTI MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-25
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7470208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty