Provider Demographics
NPI:1437151743
Name:ESTAFANOUS, MARCUS FAWZY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:FAWZY GEORGE
Last Name:ESTAFANOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SHARON NEW CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:FARRELL
Mailing Address - State:PA
Mailing Address - Zip Code:16121-1576
Mailing Address - Country:US
Mailing Address - Phone:724-248-2020
Mailing Address - Fax:
Practice Address - Street 1:350 SHARON NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1576
Practice Address - Country:US
Practice Address - Phone:724-248-2020
Practice Address - Fax:724-936-2021
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421528207W00000X, 207WX0107X
OH35082776207W00000X
OH35.082776207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2418548Medicaid
PA0019602450001Medicaid
PAP00043294Medicare PIN
OH2418548Medicaid
PA0019602450001Medicaid
OHP00043281Medicare PIN
OH4110603Medicare PIN
OHH41409Medicare UPIN
OH4110601Medicare PIN