Provider Demographics
NPI:1497884910
Name:PALACE, MARCIA RASHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:RASHELLE
Last Name:PALACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 FDR DR APT 207
Mailing Address - Street 2:APT 207
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5929
Mailing Address - Country:US
Mailing Address - Phone:212-677-8179
Mailing Address - Fax:
Practice Address - Street 1:1770 GRAND CONCOURSE
Practice Address - Street 2:SUITE 2G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:718-960-1279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210670207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3X2611Medicare ID - Type Unspecified
NYH76949Medicare UPIN