Provider Demographics
NPI:1659342186
Name:TERESITA C. MARCELO, M.D., INC.
Entity Type:Organization
Organization Name:TERESITA C. MARCELO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:CALIBAG
Authorized Official - Last Name:MARCELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-823-3166
Mailing Address - Street 1:131 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4753
Mailing Address - Country:US
Mailing Address - Phone:330-823-3166
Mailing Address - Fax:330-823-3166
Practice Address - Street 1:131 W STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4753
Practice Address - Country:US
Practice Address - Phone:330-823-3166
Practice Address - Fax:330-823-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0285463Medicaid
OH0418562Medicare PIN
OH0285463Medicaid