Provider Demographics
NPI:1821054362
Name:TARGINO, MARCELO CORDEIRO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:CORDEIRO
Last Name:TARGINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0001
Mailing Address - Country:US
Mailing Address - Phone:267-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:5 ALUMNI DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2128
Practice Address - Country:US
Practice Address - Phone:603-580-7525
Practice Address - Fax:603-580-7542
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13520207R00000X, 208M00000X
MA215541207R00000X, 2083P0500X
PAMD448185208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30206838Medicaid
NH000116802Medicare PIN