Provider Demographics
NPI:1437287208
Name:MARCUS, DAVID LOREN (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LOREN
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 338
Mailing Address - Street 2:10573 W. PICO BLVD
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:424-402-9847
Mailing Address - Fax:626-219-6658
Practice Address - Street 1:200 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-4516
Practice Address - Country:US
Practice Address - Phone:310-522-8700
Practice Address - Fax:310-549-8700
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA781532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA78153AMedicare PIN
CAH07634Medicare UPIN