Provider Demographics
NPI:1508875774
Name:FLECKER, MARCY JO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:JO
Last Name:FLECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCY
Other - Middle Name:JO
Other - Last Name:GOISSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 RIDGEVIEW DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-1650
Mailing Address - Country:US
Mailing Address - Phone:724-569-8100
Mailing Address - Fax:724-569-8368
Practice Address - Street 1:105 LAUREL VIEW DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-8908
Practice Address - Country:US
Practice Address - Phone:724-569-8100
Practice Address - Fax:724-569-8368
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072269-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009167460001Medicaid
H48558Medicare UPIN
PA1009167460001Medicaid