Provider Demographics
NPI:1629066485
Name:NASHELSKY, MARCUS B (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:B
Last Name:NASHELSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-353-7594
Mailing Address - Fax:319-384-8052
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-7594
Practice Address - Fax:319-384-8052
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35007207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0291427Medicaid
IA34071OtherWELLMARK BCBS
IA1291427Medicaid
IA33999OtherWELLMARK BCBS
IA1291427Medicaid
IAI9672004Medicare PIN
IA33999OtherWELLMARK BCBS
IAI9357Medicare PIN
IAI9954Medicare PIN
IAI0923271Medicare PIN
IAP00050285Medicare PIN