Provider Demographics
NPI:1760455000
Name:MARCARELLI, PATRICE ANN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:ANN
Last Name:MARCARELLI
Suffix:
Gender:F
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:PO BOX 17687
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-7687
Mailing Address - Country:US
Mailing Address - Phone:310-670-2099
Mailing Address - Fax:866-451-2079
Practice Address - Street 1:PO BOX 17687
Practice Address - Street 2:# 1442
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-7687
Practice Address - Country:US
Practice Address - Phone:310-672-2099
Practice Address - Fax:866-451-2079
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39993207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A399930Medicaid
CAA39993Medicare PIN