Provider Demographics
NPI:1578864658
Name:THOMAS J MARCISZ MD A MED CORP
Entity Type:Organization
Organization Name:THOMAS J MARCISZ MD A MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCISZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-739-8314
Mailing Address - Street 1:624 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4403
Mailing Address - Country:US
Mailing Address - Phone:760-739-8314
Mailing Address - Fax:760-745-4633
Practice Address - Street 1:624 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4403
Practice Address - Country:US
Practice Address - Phone:760-739-8314
Practice Address - Fax:760-745-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60509207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty