Provider Demographics
NPI:1780644963
Name:MARCILLLE, ROXANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:MARCILLLE
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 1:2113 ADAMS GROVE ROAD, SUITE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:RI
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-748-7555
Mailing Address - Fax:803-748-9555
Practice Address - Street 1:2113 ADAMS GROVE ROAD, SUITE 210
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:RI
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-748-7555
Practice Address - Fax:803-748-9555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC129472080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE72873Medicare UPIN