Provider Demographics
NPI:1598026395
Name:COREY H. MARCO, INC.
Entity Type:Organization
Organization Name:COREY H. MARCO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:HALE
Authorized Official - Last Name:MARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-442-0424
Mailing Address - Street 1:280 AVOCADO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4604
Mailing Address - Country:US
Mailing Address - Phone:619-442-0424
Mailing Address - Fax:619-442-8517
Practice Address - Street 1:280 AVOCADO AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4604
Practice Address - Country:US
Practice Address - Phone:619-442-0424
Practice Address - Fax:619-442-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23298Medicare UPIN
CAA22907Medicare PIN