Provider Demographics
NPI:1639674161
Name:DAVID MARCUS MD, INC.
Entity Type:Organization
Organization Name:DAVID MARCUS MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-702-7124
Mailing Address - Street 1:10573 W. PICO BLVD P.O. BOX 338
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:626-219-6657
Mailing Address - Fax:626-219-6658
Practice Address - Street 1:107 S. FAIR OAKS AVENUE
Practice Address - Street 2:SUITE #315
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-219-6657
Practice Address - Fax:626-219-6658
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID MARCUS MD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty