Provider Demographics
NPI:1518032713
Name:MARCO, ELYSA JILL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELYSA
Middle Name:JILL
Last Name:MARCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:350 PARNASSUS AVE
Mailing Address - Street 2:STE 609
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0137
Mailing Address - Country:US
Mailing Address - Phone:415-353-2567
Mailing Address - Fax:415-353-2400
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:STE 609
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-2567
Practice Address - Fax:415-353-2400
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA781522080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA78152OtherLICENSE
CA00A781520Medicaid
CAA78152OtherLICENSE